Fill and Sign the Respondent Person to Be Protected Form

Page 1 of 3 AS 13.26.445 PG -102 (3/17)(cs) Probate Rule 17 EMERGENCY PETITION FOR APPOINTMENT OF A TEMPORARY CONSERVATOR IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Protective Proceeding of ) ) ) ) ) ) CASE NO. Respondent (person to be protected) ) ) EMERGENCY PETITION FOR APPOINTMENT OF A TEMPORARY CONSERVATOR (AS 13.26.4 45) [ This form may be filed only if the PG- 100 or other petition for appointment of a conservator or full guardian has been filed .] 1. Petitioner's Name Age Mailing Address (box or street number) (city) (state) (ZIP) E-mail address Home Phone Cell Phone Work Phone Relationship to Respondent 2. A Petition for Appointment of a Conservator or Full Guardian for the above-named respondent has been filed, but the court has not yet appointed either a conservator or a full guardian. 3. A petition to protect the respondent from financial abuse has has not been filed. Case Number: 4. Respondent is now physically located at: Address: Phone 5.I believe the respondent needs a temporary conservator to: a. protect respondent against waste or dissipation of the following money or property: b. manage the following personal financial affairs or business affairs: Page 2 of 3 AS 13.26.445 PG -102 (3/17)(cs) Probate Rule 17 EMERGENCY PETITION FOR APPOINTMENT OF A TEMPORARY CONSERVATOR c. obtain the following money that is needed for the immediate support, care, and welfare of the respondent or persons entitled to be supported by the respondent: 6. Respondent is not capable of protecting the respondent’s money or property, managing the above personal financial affairs or business affairs, or obtaining the money that is needed to support the respondent or persons whom the respondent is required to support because: 7. Therefore, I request that the court appoint a temporary conservator to protect the respondent’s money and property or to obtain the necessary money. I understand that the temporary conservator’s appointment will expire when a regular (full or partial) conservator or a full guardian (with conservator powers) is appointed or when the petition for appointment of a conservator or full guardian is dismissed. 8. I recommend that the following person or agency be appointed temporary conservator: Name Phone Address This person's relationship to respondent is This person's priority for appointment under AS 13.26.465 is Names and addresses of persons with higher priority are: Date Signature of Petitioner or Petitioner's Attorney If attorney, print name and bar number: Page 3 of 3 AS 13.26.445 PG -102 (3/17)(cs) Probate Rule 17 EMERGENCY PETITION FOR APPOINTMENT OF A TEMPORARY CONSERVATOR 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: Certificate of Service [ Write names on the blank lines and check the boxes that show how the petition was delivered .] I certify that on , a copy of this petition was mailed or delivered to: (date) Respondent by certified mail * process server first-class mail hand-delivery by Respondent's attorney (name) by certified mail * process server first-class mail hand-delivery by Date Signature of Petitioner * If you use certified mail, you can file form PG-117 as proof of service after you get the green card back from the Post Office.