Free IN THE SUPERIOR COURT FOR THE STATE OF ALASKA - Alaska

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 Mailing Address Home Phone Relationship to Respondent 2. 3. A Petition for Appointment of a Guardian for the above-named respondent has been filed, but a guardian has not yet been appointed. Respondent is now located at: Address: 4. Phone (box or street number) (city) Work Phone (state) Age (ZIP)

I believe the respondent needs the following emergency services to protect him/her against serious injury, illness or disease:

Page 1 of 2 PG -101 (9/02)(cs) EMERGENCY PETITION FOR APPOINTMENT OF A TEMPORARY GUARDIAN

AS 13.26.140

5.

Respondent is not capable of procuring the necessary services because:

6.

Therefore, I request that the court appoint a temporary guardian to authorize the necessary services. I understand that the temporary 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. I recommend that the following person be appointed temporary guardian: Name Address This person's relationship to respondent is Phone

7.

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 Subscribed and sworn to or affirmed before me at . on (date) (SEAL) Petitioner's Signature , Alaska

Clerk of Court, Notary Public, or other person authorized to administer oaths. My commission expires:

Page 2 of 2 PG -101 (9/02)(cs) EMERGENCY PETITION FOR APPOINTMENT OF A TEMPORARY GUARDIAN

AS 13.26.140