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Infant Guardianship – Form 1 / 6-04 Page 1 of 3 IN THE ____________ COURT OF ____________________ COUNTY, WEST VIRGINIA IN THE MATTER OF: ________________________________________ Civil Action No. ________________________________________ ______-______-______ ________________________________________ Minor(s) Under the Age of 18 Years PETITION FOR APPOINTMENT OF GUARDIAN I, _______________________________, pursuant to West Virginia Code § 44-10-3, hereby request that the C ourt appoint a guardian for the following minor(s): Nam e A ge D ate o f B ir th ______________________________ ______________ ________________________ ______________________________ ______________ ________________________ ______________________________ ______________ ________________________ 1. Each minor named above is: (check one) □ a current resident of this county and state. □ a nonresident of the state but has an estate (real property or other assets) in this county. 2. This guardianship petition is requesti ng that a guardian be appointed over the (check one or both) □ person of the minor(s) and/or □ estate of the minor(s). 3. The parents of the minor(s) are: Name Address Deceased? Father:_______________________ _______________________ □ _______________________ Mother:______________________ _______________________ □ _______________________ Infant Guardianship – Form 1 / 6-04 Page 2 of 3 4. The proposed guardian(s) of the minor(s) is/are: (Check and complete one or two as appropriate, depending upon whether one guardian is sought over the person and/or the estate, or different guardians are sought over the person and the estate.) □ The above-named father over the □ person / □ estate of the minor(s). □ The above-named mother over the □ person / □ estate of the minor(s). □ Another individual named below over the □ person / □ estate of the minor(s). □ A corporation or trust company, named below, as guardian over the estate of the minor(s), which [unless for nonresident mino r(s)] is a corporation organized under the laws of this state and doing bus iness in this state or a banking institution authorized to exercise trust and fiduciary powers within this state. 5. The proposed guardian(s) is/are competent and fit to serve as guardian(s) of the (check one or both) : □ person and/or □ estate of the minor(s); and the welfare and best interests of minor(s) will be properly protected by the appointment of the proposed guardian(s). 6. The estate of each minor consists of: (If this petition seeks guardianship over the estate of each minor named herein, separately describe and estimate the value of all real property a nd other assets constituting each child’s estate.) _____________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Name:___________________________________________________ Address:_________________________________________________ Date of Birth:_____________________________________________ Relationship (if any) to minor(s):_____________________________ Name:___________________________________________________ Address:_________________________________________________ ________________________________________________________ Infant Guardianship – Form 1 / 6-04 Page 3 of 3 7. The appointment of a curator (check one) □ is / □ is not needed to protect the welfare and best interests of the minor(s) until a guardian is appointed by this Court and provides any required bond. 8. In support of this Petition, th e petitioner further states: (Add any other facts or reasons relevant to request for guardian.) _____________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________ WHEREFORE, based upon the foregoing, and upon a hearing to be held in this matter, the undersigned petitioner requests that the Court appoint the above-proposed guardian(s) of the herein-named minor(s), and grant such ot her relief the Court finds appropriate. Dated this ________ day of _______________________, 20_______. STATE OF WEST VIRGINIA COUNTY OF ____ ____________, to-wit: I, _______________________________, on oath or affirmation, say that I am the petitioner named in this PETITION and that the fact s contained herein are true, except that where they are stated to be on information and belief, I believe them to be true. ______________________________ P ETIT IO NER Taken, subscribed, and sworn or affi rmed before me this ________ day of _______________________, 20_______. My commission expires: . ______________________________ Notary Public VERIFICATION