Free 852 - Kentucky

AOC-852 Rev. 7-99 Page 1 of 2

Doc. Code: PGM or PCM

Case No._______________________ Court___________________________

Commonwealth of Kentucky Court of Justice KRS 387.025, KRS 395.016

PETITION FOR APPOINTMENT OF GUARDIAN/CONSERVATOR FOR MINOR

County_________________________

SS# or EIN# (If any) ________________________
Voluntary

NOTE TO PETITIONER: A verified application for appointment as guardian/limited guardian/conservator must accompany this form. AOC 853 may be used. In re estate of _____________________________________________________________, a minor under the age of 18. Petitioner, __________________________________________________________, petitions this Court for appointment of a (choose one):

u u u

guardian (individual, agency, or corporation having care, custody, and control of minor and managing minor's financial resources); or limited guardian (individual, agency, or corporation having care, custody, and control of minor without managing minor's financial resources); or conservator (individual, agency, or corporation managing minor's financial resources) for the above named minor.

In support of this petition, petitioner states as follows: 1. 2. 3. Minor's address is _________________________________________________________________________________. Minor's date of birth is _____________________________________________________________________________. Name and address of minor's spouse is ____________________________________________________________

___________________________________________________________________________________________________________. 4. Name(s) and address(es) of minor's living parent(s) is (are) __________________________________________

____________________________________________________________________________________________________________. 5. If no living parent(s), name(s) and address(es) of minor's adult next of kin is (are) _____________________

___________________________________________________________________________________________________________. 6. Name and address of individual or facility having custody of minor is ________________________________

____________________________________________________________________________________________________________. 7. Facts and reasons supporting need for appointment are: __________________________________________

____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________. 8. Description and value of estate: Description a. b. c. Real Property Personal Property Other Financial Resources: (1) (2) Government Benefits Insurance Entitlement ______________________________________ ______________________________________ $ ____________________ $ ____________________ ______________________________________ ______________________________________ Value $ ____________________ $ ____________________

AOC-852
Rev. 7-99 Page 2 of 2

Doc. Code PGM or PCM

(3)

Anticipated Yearly Income Other

______________________________________ ______________________________________

$ ____________________ $ ____________________

(4) 9. 10.

Petitioner's address is _____________________________________________________________________________. Name and address of petitioner's attorney is _______________________________________________________

___________________________________________________________________________________________________________. 11. Name and address of person/entity desiring appointment is ________________________________________

___________________________________________________________________________________________________________. Based on the above, petitioner prays that the above named person/entity be appointed as

u

guardian,

u

limited guardian, or u conservator. A verified application for appointment as guardian/limited guardian/ conservator for minor completed by the above named person/entity is attached.

__________________________________________________ Petitioner

SUBSCRIBED AND SWORN to before me on this date, __________________________________________, ________.

__________________________________________________ Name/Title ____________________________________________________________________________________________________________ Attorney Name & Address (If any)

Choice of Guardian by Minor age 14 or older

(This choice must be made in the presence of the Court.) The undersigned, being a minor aged 14 or older, nominates as

u guardian, u

limited guardian, or

u conservator:
__________________________________________________ Name __________________________________________________ Address

__________________________________________________ Minor Copy Distribution: Minor (If 14 or older) Each person / Entity Named in Petition Inheritance Tax Section, Revenue Cabinet, Frankfort, Kentucky 40620