Fill and Sign the Petition for Guardianship Washington Form

Superior Court of Washington County of _________________ In the Guardianship of: ____________________________ An Alleged Incapacitated Person Case No .: Petition for Guardianship of Person and/or Estate (RCW 11.88.030) (PTAPGD) I ask the court to appoint a guardian or limited guardian for __________________(name), who is an alleged incapacitated person ( AIP ). The court should consider the following information. 1. Information about the Petitioner Name: Telephone Number*: Current Residence: ______________________________ ______________________________ Post Office Address: ______________________________ ______________________________ Relationship to AIP: 2. Information about the AIP Name: ______________________________ Age: ______________________________ Current Residence: ______________________________ ______________________________ Post Office Address: ______________________________ ______________________________ Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 1 of 9 GDN 01.0100 ( 07/2017) RCW 11.88.030 3. Nature of the Alleged Incapacity The individual is incapacitated because: He or she is unable to adequately provide for nutrition, health, housing, or physical safety and is at significant risk of personal harm. He or she needs a guardian of the person. He or she is unable to adequately manage property or financial affairs and is at significant risk of financial harm. He or she needs a guardian of the estate. and/or The individual is also incapacitated because: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________. 4. Financial Information The approximate value and the description of the property owned by the AIP are: A. Assets : 1. Real Property: $________________________ 2. Stocks, Mutual Funds, & Bonds: $________________________ 3. Mortgages and Notes: $________________________ 4. Bank Accounts: $________________________ 5. Other Property: $________________________ Description of other property: The total approximate value of assets is : $________________________ The AIP receives compensation, pension, insurance, and allowances as follows: B. Income : 1. Social Security Benefits: $___________________ per month 2. Veterans’ Benefits : $___________________ per month 3. Washington State Assistance: $___________________ per month 4. Retirement Income: $___________________ per month 5. ______________________: $___________________ per month Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 2 of 9 GDN 01.0100 ( 07/2017) RCW 11.88.030 6. ______________________: $___________________ per month 7. ______________________: $___________________ per month The total approximate income is : $___________________ per month 5. Waiver of Filing Fee I do not ask the court to waive the filing fee. I ask the court to waive the filing fee because: The AIP has total assets of a value of less than $3,000. Payment of the filing fee would impose a hardship upon the AIP because: _____________________________________________________________ ____________________________________________________________. 6. Existing or Pending Guardianships or Other Court Cases There is no guardian, limited guardian, or pending guardianship action in any state for the person or the estate of the AIP. There is a guardian, limited guardian, or pending guardianship action in any state for the person or the estate of the AIP: Where is the case filed? (State or Washington State County) ______________ Was a Guardian appointed? yes no If yes: Name of guardian: ______________________________ Date of appointment: ______________________________ Type of guardianship: ______________________________ Other court cases such as protection order cases that limit contact between the AIP and other persons: Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 3 of 9 GDN 01.0100 ( 07/2017) RCW 11.88.030 7. Reason to Appoint Guardian A guardian should be appointed because: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ _____________________________________________________________________. 8. Petitioner’s Interest in Appointment My interest in the court appointing a guardian is: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ _____________________________________________________________________. 9. Protection and Assistance for the AIP The person is incapacitated to this nature and degree: ______________________________________________________________________ ______________________________________________________________________ _____________________________________________________________________. The AIP needs these specific areas of protection and assistance: ______________________________________________________________________ ______________________________________________________________________ _____________________________________________________________________. 10. Restrictions on Incapacitated Person’s Right To Communicate, Visit, Interact with Others (Laws of 2017, Ch. 268, s1) Contact with the following individuals should be restricted as specified: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________. Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 4 of 9 GDN 01.0100 ( 07/2017) RCW 11.88.030 These facts support my requests. Please be as specific as possible. You can use more paper or attach documents if you want. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________. 11. Limits on the AIP’s Rights If the court grants the petition, the court should: Revoke the following rights: To vote or hold an elected office. To marry, divorce, or enter into or end a state registered domestic partnership. To make or revoke a will. To enter into a contract. To appoint someone to act on his or her behalf. To sue and be sued other than through a guardian. To possess a license to drive. To buy, sell, own, mortgage, or lease property. To consent to or refuse medical treatment. To decide who shall provide care and assistance. To make decisions regarding social aspects of his or her life. Grant the following other limitations and restrictions: ________________________________________________________________ ________________________________________________________________ _______________________________________________________________ 12. Type of Guardianship Sought I seek the following type of guardianship: Guardianship of the person: full or limited and/or Guardianship of the estate: full or limited 13. Duration of Guardianship I request that the Guardianship exist: Until it is terminated pursuant to RCW 11.88.140; Indefinitely until the court orders that it is modified or terminated; Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 5 of 9 GDN 01.0100 ( 07/2017) RCW 11.88.030 Until the incapacitated person, who is a minor, turns 18 years old; or Other:____________________________________________________. 14. Alternatives to Guardianship The AIP did not previously make any alternative arrangements to guardianship, such as a trust or power of attorney. The AIP did previously make alternative arrangements to guardianship, such as a trust or power of attorney, as follows: ________________________________________________________________ ________________________________________________________________ _______________________________________________________________. Even though the AIP made alternative arrangements, I believe a guardianship is still necessary because: ________________________________________________________________ ________________________________________________________________ _______________________________________________________________. The AIP did did not nominate a guardian in a power of attorney or other document. The nominated guardian, if any, is (name) ____________________________________________. 15. Nomination of Guardian I am not asking the court to appoint a specific person as guardian or limited guardian. I am asking the court to appoint (name(s))_____________________ as guardian or limited guardian. The proposed guardian of the person’s residence and post office address are: Telephone Number:* Residence: ______________________________ ______________________________ Post Office Address: ______________________________ ______________________________ Relationship to AIP: The proposed guardian of the estate’s residence and post office address are: Telephone Number:* Residence: ______________________________ Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 6 of 9 GDN 01.0100 ( 07/2017) RCW 11.88.030 ______________________________ Post Office Address: ______________________________ ______________________________ Relationship to AIP: 16. Lay Guardian Training The proposed guardian, (name) ___________________ has already completed lay guardian training. Evidence that he or she successfully completed the training is attached to the petition or filed separately. I am requesting a quick (expedited) appointment of a guardian because of urgent circumstances. I request an extension of up to 90 days after appointment for the guardian to complete and file proof of completion of the training because: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________. (If the court grants your request, evidence of successful completion of the lay guardian training will be required later.) The proposed guardian, (name) _______________________, is not required to complete lay guardian training because he or she is: a certified professional guardian, a financial institution subject to the jurisdiction of the department of financial institutions and authorized to exercise trust powers, or a federally chartered financial institution authorized to serve as a guardian of the estate. 17. Relatives As far as I know or can reasonably ascertain, the following people are most closely related by blood, marriage, or state registered domestic partnership to the AIP: Name: ______________________________ Address: ______________________________ ______________________________ Nature of Relationship: ______________________________ Name: ______________________________ Address: ______________________________ ______________________________ Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 7 of 9 GDN 01.0100 ( 07/2017) RCW 11.88.030 Nature of Relationship: ______________________________ Name: ______________________________ Address: ______________________________ ______________________________ Nature of Relationship: ______________________________ (Attach more sheets if you need to.) 18. Custodian of AIP The AIP is in the care and custody of this person or facility: Name of Person or Facility: ______________________________ Address: ______________________________ ______________________________ 19. Nomination of Guardian ad Litem I am not proposing that a specific individual act as guardian ad litem. I am proposing that a specific individual, (name) ________________ act as guardian ad litem (GAL). The proposed guardian ad litem does does not have knowledge of or a relationship to any of the parties. Explain: ________________________________________________________________ _______________________________________________________________. I nominate this person as guardian ad litem because: ________________________________________________________________ ________________________________________________________________ _______________________________________________________________. 20. Summary of Requests I ask the court to take the following action: waive the filing fee; appoint (name) ______________________________________________ as guardian of the person: full or limited and/or guardianship of the estate: full or limited; appointing a guardian ad litem for the AIP; Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 8 of 9 GDN 01.0100 ( 07/2017) RCW 11.88.030 extend the time for the guardian to complete lay guardian training; grant other requests: (explain below) _______________________________________________________________ ______________________________________________________________. I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signed at (city) ________________( state) ________on (date) ______________________. Signature Printed Name Address *Telephone/Fax Number City, State, Zip Code Email Address Presented by : ______________________________________ Signature of Petitioner/Attorney ______________________________________ Printed Name of Petitioner/Attorney, WSBA or CPG no. __________ ______________________________________ ______________________________________ Address ______________________________________ *Telephone/Fax Number ______________________________________ E-mail Address *If you do not want your personal phone number on this public form, you may list your telephone number on a separate form which may be available to parties and the court, as well as its staff and volunteers, but will not be made available to the public. Use Form WPF GDN 03.0100, Guardianship Confidential Information Form (Telephone Numbers), for this purpose. GR 22(b)(6) . Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 9 of 9 GDN 01.0100 ( 07/2017) RCW 11.88.030