Guardianship Questionnaire

Intake - Guardianship

INFORMATION ABOUT PERSON NEEDING GUARDIANSHIP A/K/A IMPAIRED PERSON


CONDITION OF IMPAIRED PERSON

INFORMATION ABOUT IMPAIRED PERSON'S MONTHLY INCOME

INFORMATION ABOUT IMPAIRED PERSON'S ASSETS

INFORMATION ABOUT IMPAIRED PERSON'S DEBTS

MISCELLANEOUS INFORMATION ABOUT IMPAIRED PERSON

INFORMATION ABOUT THE PETITIONER

(The individual or entity requesting the guardianship)

INFORMATION ABOUT THE GUARDIAN

ALL PERSON'S WHO WOULD INHERIT IF THE IMPAIRED PERSON PASSED AWAY MUST BE NOTIFIED OF THE GUARDIANSHIP PROCEEDING. THIS INCLUDES THE SPOUSE AND CHILDREN. IF THERE IS NO SPOUSE OR CHILDREN, THEN PARENTS, SIBLINGS, AUNTS/UNCLES, COUSINS, IN THAT ORDER.

INFORMATION ABOUT IMPAIRED PERSON'S SPOUSE

(If legally married, please provide spouse's information. If divorced, please provide divorce decree. If widowed, please provide death certificate of spouse)

INFORMATION ABOUT IMPAIRED PERSON'S CHILDREN & OTHER RELATIVES

(Please include all children, including adopted, step, and children from previous marriages. If any of the children are deceased, please list their children (i.e. grandchildren). If there is no spouse and no children, please list parents. If there are no living parents, please list siblings. If there are no living siblings, please list aunts/uncles, cousins, nieces and nephews, in that order.)