Georgia Probate Court Standard Form Petition for Receipt

Petition for Receipt and Acceptance of Foreign Guardianship and/or Conservatorship

GEORGIA PROBATE COURT STANDARD FORM

Effective 7/07 GPCSF 60 Petitioner

INSTRUCTIONS

I. Specific Instructions

1. This form is to be used by a guardian and/or conservator as appointed by another state to transfer the guardianship and/or conservatorship to a Georgia county pursuant to O.C.G.A. 29-2-65 et seq.; O.C.G.A. 29-3-105 et seq.; O.C.G.A. 29-4-85 et seq.; and O.C.G.A. 29-5-125 et seq.

II. General Instructions

General instructions applicable to all Georgia probate court standard forms are available in each probate court.

IN THE PROBATE COURT OF COUNTY

STATE OF GEORGIA

IN RE: ESTATE NO.

PETITION FOR RECEIPT AND ACCEPTANCE OF FOREIGN GUARDIANSHIP AND/OR CONSERVATORSHIP

TO THE HONORABLE JUDGE OF THE PROBATE COURT:

The petition of , Guardian(s) and/or Conservator(s), who reside(s) at , County, Georgia, and who is/are domiciled at: shows:

1. Petitioner(s) was/were appointed Guardian(s) and/or Conservator(s) of the above minor/ward by Order dated , as issued by the Court of County, State of . The clerk of said Court may be contacted as the following address: , telephone number .

2. The minor/ward, age , date of birth , social security no. , is currently domiciled at (address) County, State of , and is presently located at , which is a (type of facility, if applicable) and can be contacted at (telephone number): . Said minor/ward will be relocated to the following address:

3. Attached hereto as Exhibit A is an authenticated copy of:

a. the order establishing the guardianship and/or conservatorship, with all attachments describing the duties and powers of the guardian and/or conservator;

b. any orders modifying the order referenced in a above, including, if any, orders of transfer.

4. Regarding other guardianship and/or conservatorship petitions pending, (initial one)

a. there are none

b. there is one; it has been filed in the Court of County, State of , .

5. (initial one):

a. The guardianship and/or conservatorship is of a minor. The following are the adult siblings of the minor:

NAME ADDRESS

NAME ADDRESS

NAME ADDRESS

NAME ADDRESS

b. The guardianship and/or conservatorship is of an adult ward. Pursuant to law, the names, addresses, and relationships of the persons to be notified are as follows:

(NOTE: The law requires notice to be given to the spouse, if any, and to all living children, if any, whose addresses are known. If there are no living adult children whose addresses are known, then list at least two adults in the following order of priority: lineal descendants of the proposed ward; parents and siblings of the proposed ward; and friends of the proposed ward. In determining the persons to whom notice is required to be given according to the foregoing rules, the petitioner(s) should not be counted as persons receiving notice.)

NAME AGE ADDRESS RELATION

NAME AGE ADDRESS RELATION

NAME AGE ADDRESS RELATION

6. The following individuals, other than Petitioner(s), are caring for the minor/ward; have been appointed as guardian for the minor/ward; or have been appointed conservator for the minor/ward (or enter "not applicable"):

NAME ADDRESS RELATIONSHIP OR APPOINTED TITLE

NAME ADDRESS RELATIONSHIP OR APPOINTED TITLE

NAME ADDRESS RELATIONSHIP OR APPOINTED TITLE

7. The following individual(s), other than Petitioner(s), is/are acting as legal representative, legal counsel, guardian ad litem, or court visitor by the court having jurisdiction over the current guardianship and/or conservatorship (or enter "not applicable"):

NAME ADDRESS RELATIONSHIP OR APPOINTED TITLE

NAME ADDRESS RELATIONSHIP OR APPOINTED TITLE

8. If there is a conservatorship, the following is the name and address of the surety on the conservator's bond (or enter "not applicable"):

NAME ADDRESS

9. All known income and assets of the proposed ward are shown on page 6 attached hereto.

10. The transfer of said guardianship and/or conservatorship to Georgia is in the best interest of the minor/ward because

11. Additional Data: Where full particulars are lacking, state here the reasons for any such omission.

WHEREFORE, your Petitioner(s) pray(s) that

1. notice be served as required by law;

2. a hearing be held on the matter; and

3. this Court receive and accept the foreign guardianship and/or conservatorship.

Signature of Attorney:

Typed/printed name of Attorney:

Address:

Telephone: State Bar #

VERIFICATION

GEORGIA, COUNTY

Personally appeared before me the undersigned Petitioner(s) who on oath state(s) that the facts set forth in the foregoing petition are true.

ASSETS, INCOME, OTHER SOURCES OF FUNDS OF WARD

WARD:

REAL PROPERTY

(Indicate if property is jointly owned and with whom)

Description County State Approximate equity $

Description County State Approximate equity $

Description County State Approximate equity $

INCOME FROM ALL SOURCES

Social Security per year $

SSI (Supplemental Security Income) per year $

Retirement benefits per year $

VA benefits per year $

Other income per year, including, e.g., alimony, annuity, or trust distributions $

Interest, dividend, or investment income $

YEARLY TOTAL OF ALL INCOME $

PERSONAL AND INTANGIBLE PROPERTY

(Indicate if property is jointly owned and with whom)

1. Checking/Savings/Money Market/Certificates of Deposit/Liquid Accounts:

Bank/Financial Institution/Broker Acct. No. Joint Owner (if any) $

Bank/Financial Institution/Broker Acct. No. Joint Owner (if any) $

Bank/Financial Institution/Broker Acct. No. Joint Owner (if any) $

Bank/Financial Institution/Broker Acct. No. Joint Owner (if any) $

2. Stocks/Bonds/Investments (including retirement and profit-sharing accounts):

a. held by brokers:

Brokerage Firm or Institution Acct. No. Joint Owner (if any) $

Brokerage Firm or Institution Acct. No. Joint Owner (if any) $

Brokerage Firm or Institution Acct. No. Joint Owner (if any) $

b. privately held:

Company/Issuer No. of Shares Joint Owner (if any) $

Company/Issuer No. of Shares Joint Owner (if any) $

Company/Issuer No. of Shares Joint Owner (if any) $

3. Automobiles:

Year/Make/Model V.I.N. Joint owner (if any) $

Year/Make/Model V.I.N. Joint owner (if any) $

4. Other assets of significant value:

Description Joint owner (if any) $

Description Joint owner (if any) $

Description Joint owner (if any) $

TOTAL VALUE OF PERSONAL AND INTANGIBLE PROPERTY $

ACKNOWLEDGMENT OF SERVICE

IN RE: Estate of ESTATE NO.

Due and legal service of the Petition for Receipt and Acceptance of Foreign Guardianship is hereby acknowledged by the following interested persons as shown in paragraphs 5, 6, 7, and 8. The undersigned acknowledges that he/she has received a copy of the Petition and all further service and notice is waived.

SIGNATURE(S)

Sworn to and subscribed before me this day of , 20 .

My Commission Expires

Sworn to and subscribed before me this day of , 20 .

My Commission Expires

Sworn to and subscribed before me this day of , 20 .

My Commission Expires

Sworn to and subscribed before me this day of , 20 .

My Commission Expires

Sworn to and subscribed before me this day of , 20 .

My Commission Expires