Fill and Sign the Georgia Probate Court Standard Form Petition for Receipt

GEORGIA PROBATE COURT STANDARD FORM Effective 7/07GPCSF 60 PetitionerPetition for Receipt and Acceptance of Foreign Guardianship and/or Conservatorship INSTRUCTIONS I.Specific Instructions1.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 InstructionsGeneral instructions applicable to all Georgia probate court standard forms are available in each probate court. Effective 7/07GPCSF 60 Petitioner IN THE PROBATE COURT OF COUNTY STATE OF GEORGIA IN RE: )ESTATE NO. ____________________ ) , )PETITION FOR RECEIPT AND MINOR/WARD )ACCEPTANCE OF FOREIGN )GUARDIANSHIP AND/OR )CONSERVATORSHIPTO 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: Effective 7/07GPCSF 60 Petitionera.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 noneb. there is one; it has been filed in the Court of County, State of , (address) . 5. (initial one):a. The guardianship and/or conservatorship is of a minor. The following are the adult siblings of the minor: 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 (or over 18) ADDRESS RELATION Effective 7/07GPCSF 60 Petitioner_____________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________ _____________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________ 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 ):NAMEADDRESS 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 )NAMEADDRESS RELATIONSHIP OR APPOINTED TITLE _____________________________________________________________________________________ _____________________________________________________________________________________ __________________________________________________________________________________ 8.If there is a conservatorship, the following is the name and address of the surety on the Effective 7/07GPCSF 60 Petitionerconservators 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. Effective 7/07GPCSF 60 PetitionerWHEREFORE, 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 Petitioner Signature of second Petitioner, if any _____________________________________ Printed NamePrinted Name _____________________________________ Address Address _____________________________________ _____________________________________ Telephone NumberTelephone NumberSignature of Attorney: ___________________________________________ Typed/printed name of Attorney:______________________________________________ Address: ______________________________________________ Telephone: State Bar # ________________ VERIFICATION GEORGIA, COUNTYPersonally appeared before me the undersigned Petitioner(s) who on oath state(s) that the facts set forth in the foregoing petition are true.Sworn to and subscribed beforeme this day of , 20 . _____________________________________Petitioner _____________________________________ NOTARY/CLERK OF PROBATE COURT Printed NameMy Commission Expires ------------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed beforeme this day of , 20 . ______________________________________ Second Petitioner, if any ______________________________________ NOTARY/CLERK OF PROBATE COURT Printed NameMy Commission Expires Effective 7/07GPCSF 60 Petitioner 7 ASSETS, INCOME, OTHER SOURCES OF FUNDS OF WARD WARD: REAL PROPERTY(Indicate if property is jointly owned and with whom) Description CountyState Approximate equityParcel 1 $ Parcel2 $ Parcel3 $ INCOME FROM ALL SOURCES Yearly TotalSocial 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) Approximate Current Value1. Checking/Savings/Money Market/Certificates of Deposit/Liquid Accounts: Bank/Financial Institution/Broker Acct. No.Joint Owner (if any) $ $ $ $ Effective 7/07GPCSF 60 Petitioner 8 2. Stocks/Bonds/Investments (including retirement and profit-sharing accounts): a. held by brokers: Brokerage Firm or InstitutionAcct. No.Joint Owner (if any) $ $ $ $ $ b. privately held: Company/IssuerNo. of SharesJoint Owner (if any) $ $ $ 3. Automobiles: Year/Make/ModelV.I.N.Joint owner (if any) $ $ 4. Other assets of significant value: DescriptionJoint owner (if any) $ $ $ TOTAL VALUE OF PERSONAL AND INTANGIBLE PROPERTY $ GEORGIA PROBATE COURT STANDARD FORMEffective 7/07GPCSF 60 Petitioner 9 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 beforeme this day of , 20 . ____________________________________ NOTARY/CLERK OF PROBATE COURT Printed NameMy Commission Expires ------------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed beforeme this day of , 20 . ____________________________________ NOTARY/CLERK OF PROBATE COURT Printed NameMy Commission Expires -------------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed beforeme this day of , 20 . NOTARY/CLERK OF PROBATE COURT Printed NameMy Commission Expires -------------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed beforeme this day of , 20 . NOTARY/CLERK OF PROBATE COURT Printed NameMy Commission Expires ----------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed beforeme this day of , 20 . ___________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name My Commission Expires