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Q Terminate Q Modify the Order of Q Partial Disability Q Disability Entered on 2 Form

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In the matter of the guardianship/conservatorship of ___________________\ __________________________________ Comes the Peti tioner ____ ______________________________________________________ and requests the Court: 1. q Terminate q Modify the order of q partial disability q disability entered on ____________________, 2____ as follows: ____________________________________________________________\ ____________________ ________________________________________________________________________\ _________________ ________________________________________________________________________\ _________________ q Remove the present fiduciary and replace with _________________________________________________. q Renew the appointment of the present fiduciary for a period of _____________________________________. AOC-795 Doc. Code: PRMT Rev. 7-18 Page 1 of 2 Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 387.610; 387.620 PETITION FOR RELIEF, MODIFICATION OR TERMINATION lex et justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE DISTRICT In support of this request, Petitioner states: 2. Ward's address: ______________________________________________________ County: ______\ ________ Name and a ddress of the individual or facility, if any, having custody of the ward: Name: _____________________________________________________________ Add ress: ____________________________________________________________ Cou\ nty: ______________ 3. Ward's p resent fiduciary: _____________________________________________________________________ Address: _______________________________________________________________\ ___________________ Appo inted on: ______________________________________________________________\ ________________ As: q Li mited Guardian q Limited Conservator q Gu ardian q Conservator 4. Ward's next of kin are: Name Address Relationship ______________________________ ______________________________ _____________________________ ______________________________ ______________________________ _____________________________ _____ _________________________ ______________________________ _____________________________ 5. The fact s and reasons supporting this request: ________________________________________________________________________\ _________________ ________________________________________________________________________\ _________________ ______ ________________________________________________________________________\ ___________ Date * * * * * * * * * * * * Ward Case No. ____________________ Court ____________________ County ____________________ Division ____________________ WHEREFORE, the Petitioner requests that this court conduct a hearing within thirty (30) days of the filing of this petition in the county of the ward’s current residence or domicile, or, if the ward is a minor, where the parent of the ward is domiciled. KRS 387.520(2) . If the foregoing petition is for a renewal of the appointment of a limit\ ed guardian or conservator, it shall be accompanied by verified affidavits of a physician, an advanced practice registered nurse, or a physician assistant; a licensed or certified psychologist under KRS Chapter 319; and a licensed or certified social worker or an employee of the Cabinet for Health and Family Services who is qualified under KRS 335.080(1)(a), (b), and (c) or KRS 335.090(1) (a), (b), and (c) in support of same pursuant to KRS 387.610 . ____________________________________________ _ Petitioner _____________________________________________ Address _____________________________________________ Relationship to Ward To be completed if Petitioner is represented by counsel: _____________________________________________ Signature of Attorney _____________________________________________ Address of Attorney _____________________________________________ Telephone Number A copy of this Petition was mailed this date to the Ward, the attorney of record, the county attorney and all persons named in the Petition. _________________________________________ _______________________________________ Clerk Date _____________________________________ By: D.C. AOC-79R Rev. 7-18 Page 2 of O

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