Fill and Sign the Pg 101 State of Alaska Form

Page 1 of 2 PG -101 (9/02)(cs) AS 13.26.140 EMERGENCY PETITION FOR APPOINTMENT OF A TEMPORARY GUARDIAN IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Protective Proceeding of ) ) ) ) ) ) CASE NO. Respondent ) ) EMERGENCY PETITION FOR APPOINTMENT OF A TEMPORARY GUARDIAN (AS 13.26.140) [This form may be filed only if the PG-100 Petition is also filed .] 1. Petitioner's Name Age Mailing Address (box or street number) (city) (state) (ZIP) Home Phone Work Phone Relationship to Respondent 2. A Petition for Appointment of a Guardian for the above-named respondent has been filed, but a guardian has not yet been appointed. 3. Respondent is now located at: Address: Phone 4. I believe the respondent needs the followi ng emergency services to protect him/her against serious injury, illness or disease: Page 2 of 2 PG -101 (9/02)(cs) AS 13.26.140 EMERGENCY PETITION FOR APPOINTMENT OF A TEMPORARY GUARDIAN 5. Respondent is not capable of procuring the necessary services because: 6. Therefore, I request that the court appoi nt a temporary guardian to authorize the necessary services. I understand that the te mporary guardian's appointment will expire when a regular (full or partial) guardian is appointed or when the petition for appointment of a guardian is dismissed. 7. I recommend that the following pers on be appointed temporary guardian: Name Phone Address This person's relationship to respondent is Date Signature of Petitioner or Petitioner's Attorney If attorney, print name and bar number: Verification I state on oath or affirm that I have read this petition and that all statements made in it are true to the best of my knowledge and belief. Date Petitioner's Signature Subscribed and sworn to or affirmed before me at , Alaska on . (date) (SEAL) Clerk of Court, Notary Public, or other person authorized to administer oaths. My commission expires: