Guardianship Registry Information Sheet

Guardianship Registry Information Sheet

(☐ Individual ☐Estate ☐ Estate and Individual)

Choose One*(☐ Minor ☐Adult) Choose One*(☐ Temporary ☐ Permanent)

Related Cases (List any cases in which the Protected Person is a party, e.g., CHINS)

______

PetitionerRelationship to Protected Person* ______

Last:*______Suffix:_____ First:*______Middle:______

DOB:______Gender:*_____ Race:*______Hispanic?: Yes/No

Address:*______

Home Phone:______Work Phone:______Cell Phone:______

Email Address:*______

Attorney Name:______Bar Number:______App. Filed Date: ______

Protected PersonEstimated Value $______

Last:*______Suffix:_____ First:*______Middle:______

DOB:*______Gender:*_____ Race:*______Hispanic?: Yes/No

Eye Color:______Hair Color:______Height:______Weight:______lbs

Scars, Marks, and Tattoos: ______

Address:*______

Home Phone:______Work Phone:______Cell Phone:______

Email Address:______

Attorney Name:______Bar Number:______App. Filed Date: ______

Guardian Ad Litem Full Name:______

Interpreter required? Yes/No Language: ______

Guardian ☐ Check if same as petitioner ☐ Certified (Only check if Federal or State Certified)

Last:*______Suffix:_____ First:*______Middle:______

DOB:______Gender:*_____ Race:*______Hispanic?: Yes/No

Address:*______

Home Phone:______Work Phone:______Cell Phone:______

Email Address:*______

Attorney Name:______Bar Number:______App. Filed Date: ______

Guardian Institution

Name:*______

Address:*______

Phone:______Fax:______Agent Name:______

Close Relative (Entitled to Notice)Relationship to Protected Person ______

Last:*______Suffix:_____ First:*______Middle:______

Gender:*_____ Race:*______Hispanic?: Yes/No

Mailing Address:*______

Home Phone:______Work Phone:______Cell Phone:______

Email Address:______

Guardianship Registry Information Sheet

(Additional)

PetitionerRelationship to Protected Person ______

Last:*______Suffix:_____ First:*______Middle:______

DOB:______Gender:*_____ Race:*______Hispanic?: Yes/No

Address:*______

Home Phone:______Work Phone:______Cell Phone:______

Email Address:______

Attorney Name:______Bar Number:______App. Filed Date: ______

Guardian ☐ Check if same as petitioner ☐ Certified (Only check if Federal or State Certified)

Last:*______Suffix:_____ First:*______Middle:______

DOB:______Gender:*_____ Race:*______Hispanic?: Yes/No

Address:*______

Home Phone:______Work Phone:______Cell Phone:______

Email Address:______

Attorney Name:______Bar Number:______App. Filed Date: ______

Close Relative (Entitled to Notice)Relationship to Protected Person ______

Last:*______Suffix:_____ First:*______Middle:______

Gender:*_____ Race:*______Hispanic?: Yes/No

Mailing Address:*______

Home Phone:______Work Phone:______Cell Phone:______

Email Address:______

Interested Party

Last:*______Suffix:_____ First:*______Middle:______

Gender:*_____ Race:*______Hispanic?: Yes/No

Address:*______

Home Phone:______Work Phone:______Cell Phone:______

Email Address:______

Interested Party

Last:*______Suffix:_____ First:*______Middle:______

Gender:*_____ Race:*______Hispanic?: Yes/No

Address:*______

Home Phone:______Work Phone:______Cell Phone:______

Email Address:______