Free Untitled-1 - Kentucky

AOC-777 Rev. 8-03 Page 1 of 2

Doc. Code: PVA & OAG Or OCON

Case No._____________________ Court________________________ VERIFIED PETITION FOR THE VOLUNTARY APPOINTMENT OF A GUARDIAN OR CONSERVATOR AND STANDBY GUARDIAN AND ORDER County_______________________

Commonwealth of Kentucky Court of Justice www.kycourts.net KRS 387.330

IN RE: ____________________________________________ Petitioner's Full Name ____________________________________________ ____________________________________________ Address

______________________________________ Social Security No. ______________________________________ Date of Birth / Age

Pursuant to KRS 387.330, the above-named petitioner hereby requests this Court to appoint ____________________________________, ___________________________________________________________, (Name) (Address) ____________________________________________, as [ (Telephone Number) ] guardian [ ] conservator of my property. Upon the death,

resignation, removal, or incapacity of the appointed guardian or conservator, I nominate ______________________________, (Name) ____________________________________________________________________, ____________________________, (Address) (Telephone Number) as standby guardian. Petitioner requests that the appointment be made [ ] without bond or [ ] with bond to be fixed in the amount of $________________________________. The Petitioner's [ ] Durable Power of Attorney [ ] Health Care Surrogate is:

_____________________________________________ Name _____________________________________________ Address _____________________________________________ _____________________________________________ This petition is to be acted upon by the Court only upon one of the following conditions: a. Occurrence of the following event: _________________________________________________________________________________________________ _________________________________________________________________________________________________ ________________________________________________________________________________________________. The occurrence of the above event shall be established by: _________________________________________________________________________________________________. b. Existence of the following condition of the petitioner's mental or physical health: _________________________________________________________________________________________________ _________________________________________________________________________________________________ ________________________________________________________________________________________________. The existence of the above condition shall be established by: ________________________________________________________________________________________________.

AOC-777 Rev. 8-03 Page 2 of 2

Doc. Code: PVA & OAG Or OCON

Additionally, this petition is to be acted upon by the Court only if accompanied by an affidavit from a licensed physician indicating that the above-named petitioner is disabled as defined in KRS 387.510. That affidavit [ ] is attached [ ] will be filed later. The proposed ward is hereby advised that a guardian's powers are defined in KRS 387.065 and consist of the support, care and education of the ward while not being personally liable for the ward's expenses or to third parties. Specifically, a guardian has the power to take custody of the ward, establishing the ward's place of abode within the Commonwealth, and to take reasonable care of the ward's personal effects and finances. The proposed ward is also advised that a conservator's powers are defined in KRS 387.137 and unlike the guardian's powers, consist only of managing the ward's finances and assets.

_____________________________________________ Date

_____________________________________________ Signature of Petitioner

SUBSCRIBED AND SWORN TO before me this ______________ day of _____________________________, 2_______.

_____________________________________________ Name / Title _____________________________________________ County, Kentucky

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ORDER

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Having fully reviewed the above petition, and being otherwise sufficiently advised, IT IS HEREBY ORDERED that _____________________________________________________ [ ] is [ ] is not

competent and fit to be appointed as guardian or conservator. It is further ordered that _____________________________ [ ] is [ ] is not competent and fit to be appointed as standby guardian. ] guardian, [ Therefore, the Court appoints

___________________________________, as [ as standby guardian.

] conservator and ______________________________,

_____________________________________________ Date

_____________________________________________ Judge