IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON

IN AND FOR THE COUNTY OF

In the Guardianship of: An Alleged Incapacitated Person.	) ) ) ) ) ) )	Case No.: PETITION FOR GUARDIANSHIP OF PERSON AND/OR ESTATE RCW 11.88.030 (PTAPGD)

ALLEGED INCAPACITATED PERSON INFORMATION

The name, age, address of present residence, and post office address of the Alleged Incapacitated Person are:

Name:

Age:

Present Residence:

D. Post Office Address:

NATURE AND DEGREE OF ALLEGED INCAPACITY

The nature and degree of the alleged incapacity are as follows:

Nature of Alleged Incapacity:

Degree of Alleged Incapacity:

DESCRIPTION/VALUES OF PROPERTY

The approximate value and the description of the property owned by the Alleged Incapacitated Person is:

Real Property:	$

Stock, Mutual Funds and Bonds:	$

Mortgages and Notes:	$

Bank Accounts	$

Furniture:	$

Other Personal Property:	$

Total Approximate Value of Assets is:	$

DESCRIPTION/COMPENSATION, PENSION, INSURANCE, BENEFITS

There are periodic compensation, pension, insurance, and allowances as follows:

Social Security Benefits:	$/month

Veterans Benefits	$/month

Washington State Assistance	$/month

Other:	$/month

Approximate Total Monthly Income:	$

V.	EXISTING OR PENDING GUARDIANSHIPS

There is [] OR is not [] an existing or pending Guardianship action for the person and/or the estate of the Alleged Incapacitated Person. If there is an existing or pending Guardianship, set forth the following:

State Where Guardianship/Limited Guardianship Pending or Established:

Name of Guardian/Limited Guardian:

Date of Appointment:

Type of Guardianship:

VI.	NOMINEE

The name, address, telephone number, date of birth, and age of the proposed Guardian and the relationship of the Alleged Incapacitated Person are as follows:

Name of Nominee:

Address:

Telephone Number:

Age:

Relationship to Alleged Incapacitated Person:

VII.	RELATIVES

The name and addresses, and the nature of the relationship of the persons most closely related by blood or marriage to the Alleged Incapacitated Person are as follows:

Name:

Address:

Relationship:

Name:

Address:

Relationship:

Name:

Address:

Relationship:

VIII.	CUSTODIAN OF PERSON TO BE ASSISTED

The name, address, and telephone number of the person or facility having the care and custody of the Alleged Incapacitated Person and the length of time of said care and custody is:

Name:

Address:

Telephone:

Length of Time at Facility:

IX.	REASON FOR GUARDIANSHIP

The reason for petitioning for Guardianship is as follows:

If necessary, continue on separate sheet of paper and attach to this petition.

The interest of the Petitioner in the appointment is as follows:

If necessary, continue on separate sheet of paper and attach to this petition.

Designate whether the appointment is sought as Guardian or Limited Guardian of the Person, the Estate, or both:

[] Person only OR

[] Estate only OR

[] Both Person and Estate.

Describe any alternative arrangements previously made by the Alleged Incapacitated Person, such as trusts, powers of attorney including any Guardianship nominations contained in a power of attorney, and why a Guardianship is nevertheless necessary:

If necessary, continue on separate sheet of paper and attach to this petition.

X.	AREAS OF ASSISTANCE

The nature and degree of the alleged incapacity:

If necessary, continue on separate sheet of paper and attach to this petition.

The following are specific areas of protection and assistance required:

If necessary, continue on separate sheet of paper and attach to this petition.

The duration of guardianship should be as follows:

XI.	GUARDIAN AD LITEM

A Guardian ad Litem should be appointed from the Court’s Registry.

XII.	BONDS AND FEES

A bond in the amount of $ should be

[] established OR [] waived

for the following reasons:

The payment of Guardian ad Litem’s fees should be provided by:

[] The County OR

[] The Guardianship Estate OR

[]

XIII.	SUMMARY

The Petitioner(s) request(s) the following relief:

[] An Order appointing a Guardian ad Litem for the Alleged Incapacitated Person;

[] An Order waiving the requirement for a filing fee;

[] An Order directing that the Guardian ad Litem’s fees in this matter be paid by:

______________________________________________________________

[] An Order approving payment, by Petitioner(s), of reasonable attorney’s fees and costs incurred in preparation and presentation of this Guardianship Petition; and

[] An Order appointing as

[] Full [] Limited Guardian(s) of the Person and/or Estate of subject to review in months with the bond [] waived [] set in the amount of $

[] Other relief requested:

I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.

Signed at, Washington,

200

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