Petition for Appointment of Guardian

Petition for the Appointment of a Guardian of the Person of an Alleged Disabled Person

IN THE COURT OF CHANCERY OF THE STATE OF DELAWARE

Register in Chancery - Kent County, 38 The Green, Dover, DE 19901, 302-735-1930

Register in Chancery - New Castle County, 500 N. King Street, Wilmington, DE 19801, 302-255-0544

Register in Chancery - Sussex County, 34 The Circle, Georgetown, DE 19947, 302-856-5775

Costs Involved & General Information on Acting as a Pro Se Litigant

The initial filing fee of $135.00 and an additional $2.00 per page scanning fee is required at the time you file your petition. A Delaware lawyer will be appointed as attorney ad litem for the alleged disabled person.

Petition to Appoint Guardian(s) of the Person

Petitioner(s):

1. Information about Petitioner(s)

a. Current address(es):

b. Telephone Number(s):

c. Relationship to alleged disabled person:

2. Information about the alleged disabled person

a. Age:

b. Date of birth:

c. Current address:

d. Permanent address:

e. If the alleged disabled person is a patient/living at a hospital or institution:

i. Admission date:

ii. Admitted by:

iii. Reason(s) for admission:

3. Who is paying the alleged disabled person’s expenses and out of what funds?

4. The marital status of the alleged disabled person is:

Single Married Divorced Widowed

5. Names and addresses of any potentially interested party

6. The alleged disabled person is believed to have made a Will located at:

and in the custody of

7. Has the alleged disabled person ever appointed a Power of Attorney?

Yes No

If yes, name and address of the Agent under the Power of Attorney:

8. Has the alleged disabled person been represented by a Delaware attorney within the last two years?

Yes No

If yes, include the name of the attorney, reason, and years of service:

9. Has the alleged disabled person ever been a member of the military?

Yes No

10. A list of the believed assets and estimated value are the following:

11. A list of the believed current sources of income are the following:

12. A list of the believed current sources of liabilities are listed as the following:

13. With detailed information, explain why the alleged disabled person is in need of a guardian.

14. With detailed information, explain why you are an appropriate guardian for the alleged disabled person.

15. All of the following statements must be true before the Court will consider this petition. Check all that apply:

There is currently no guardian for the person of the alleged disabled person.

The alleged disabled person is unable to properly manage and care for his/her person and is in danger of becoming the victim of a designing person or substantially endangering health or becoming subject to abuse.

The alleged disabled person lives in the State of Delaware.

Attached is the physician’s affidavit.

Doctor/Physician Name:

Doctor/Physician Office Address:

Doctor/Physician Phone Number:

Petitioner(s) consents to the Register in Chancery as agent for acceptance of service.

Wherefore, Petitioner(s) respectfully request that:

1. This Court appoint him/her/them as guardian(s) of the person of the alleged disabled person.

2. A preliminary order be entered to schedule a hearing and notify interested parties.

Sworn to and subscribed before me on the day of , .

Physician’s Affidavit

Patient’s Name:

Address:

Provider’s Name:

Provider Address:

Telephone Number:

Licensed states:

Board certified in:

History of involvement:

I personally examined on .

Examination lasted approximately .

Tests performed or ordered:

Professional opinion:

Does not have a disability that interferes with responsible decisions.

Does have a disability that interferes with responsible decisions.

Particulars of the disability:

Patient is unable to perform the following functions:

Patient has sufficient mental capacity to understand guardianship and can consent.

Patient does not have sufficient mental capacity to understand guardianship and cannot consent.

Court of Chancery Personal Information Sheet

Proposed Guardian’s current full name:

Physical address:

Mailing address (if different):

Home phone number: Work phone number:

Cell phone number: E-mail address:

Date of birth: Social Security number:

Driver’s License number and State:

Place of employment and address:

Name of supervisor and telephone number:

Name/Address/Telephone number of spouse (if not a co-petitioner/co-guardian):

Name, address and telephone number of at least two persons who should always be able to locate or contact me:

1. Name:

Address:

Phone number: Relationship:

2. Name:

Address:

Phone number: Relationship:

Affidavit of Proposed Guardian’s History

Have you ever declared bankruptcy?

Yes No

If so, when?

If so, what type?

Have you ever been convicted of a misdemeanor?

Yes No

If so, describe which misdemeanor, when and in what jurisdiction you were convicted:

Have you ever been convicted of a felony?

Yes No

If so, describe which felony, when and in what jurisdiction you were convicted:

Have you ever been found guilty of an offense by a court martial?

Yes No

If so, describe which offense and when you were found guilty:

Do you give the State of Delaware permission to conduct a criminal background check on you?

Yes No

Instructions for Notifying Interested Party(ies) of Petition for Guardianship

Interested parties may sign a Waiver of Notice and Consent or receive notice by certified mail with the Notice of Petition and Preliminary Order.

Waiver of Notice and Consent

I, , whose relationship to the alleged disabled person is , hereby waive my right to notice and consent to the appointment of as guardian for the alleged disabled person’s person.

Interested Party’s signature:

Address:

Phone Number:

Notice of Petition for the Appointment of Guardian(s) of the Person

This is a notice that I am/we are applying for guardianship of ’s Person.

Dated:

Affidavit of Mailing

The petitioner(s), , mailed on this date a Notice of Petition dated and a copy of the approved preliminary order to the following interested parties:

A copy of the Notice of Petition is attached.

The certified mail return receipts are attached.

Preliminary Order for the Appointment of an Attorney Ad Litem and to Schedule the Hearing

Hearing County: Hearing Date: Hearing Time:

Attorney ad litem:

Report due before noon on:

Final Order for Appointment of a Guardian of the Person

Hearing date:

Petitioner: Relationship:

Disabled person:

Guardian appointed:

Attorney ad litem fee: $ payable to