Affidavit Of Petitioner Regarding Medical Certification {Y}

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Code: (Your name) __________________________ (Address) __________________________ __________________________ (Telephone) __________________________ In Proper Person IN THE _____ JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF _____________________ In the Matter of the Guardianship of the Person only Estate only Person and Estate of: _______________________________, _______________________________, _______________________________, A(n) Minor. Adult. ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) CASE NO. ____________ DEPT. NO. ____________ AFFIDAVIT OF PETITIONER REGARDING MEDICAL CERTIFICATION STATE OF NEVADA COUNTY OF _________________ ) ) ) (Petitioner's name) ____________________________, being first duly sworn according to law, deposes and says: 1. 2. That I am the petitioner in this case. That I have tried to obtain a physician's certificate regarding the proposed ward's health. I have done this by (explain what steps you have taken to get the certificate) _________________________________________________________________________________ For all guardianships Affidavit of Petitioner Regarding Medical Certification 1 of 2 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 3. That I have not been able to get the certificate from the doctor. DATED THIS _____ day of _______________, _________ ____________________________________ (Signature) SIGNED and SWORN to before me by (Petitioner's name) ___________________________ on the _____ day of ____________________, _____. _________________________________ NOTARY PUBLIC OR _________________________________ DEPUTY CLERK /// /// /// /// /// /// /// // For all guardianships Affidavit of Petitioner Regarding Medical Certification 2 of 2 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com