Petition For Appointment Of Guardian For A Minor {171P-31}

IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS ESTATE OF ) ) ) ) a minor ) Gen No.: PETITION FOR APPOINTMENT OF GUARDIAN FOR A MINOR , a reputable citizen of Illinois, hereby certifies: (Petitioner) 1. Petitioner resides at: (Address) (City/State/Zip) 2. Petitioner is a(n) (Relationship to Minor) to the minor. 3. The following minor child is in need of a guardian. (birth certificate required to be presented to the Judge) (Name of Minor) (Current Address, City, State, Zip) (Date of birth - mm/dd/yyyy) (Current County of Residence) 4. The names and post-office address of the biological parents of the minor are: Mother (Name of Mother) (Address, City, State, Zip) Father (Name of Father) (Address, City State, Zip) 5. If one or both of the biological parents are no longer living (attach death certificate) and list the minor's next closest relatives: (Name) (Name) (Name) (Name) (Relationship to Minor) (Relationship to Minor) (Relationship to Minor) (Relationship to Minor) (Address, City State, Zip) (Address, City State, Zip) (Address, City State, Zip) (Address, City State, Zip) 6. The minor currently resides with and has so resided since . at 7. Does Petitioner know of any orders of any court affecting the parentage, custody or guardianship rights of the minor? Yes No If yes, describe the order and state the name and current address of any person who has an interest in the minor as a result of such order(s): 8. Petitioner is years of age; employed as (Occupation) , has never been convicted of a felony, is qualified and willing to act as guardian of the Person, Estate, Person and Estate of the minor. 9. The approximate value of the minor's personal estate is $ . . 171P-31 (R 04/10) 10. The amount of current / anticipated gross annual income, financial assistance and other receipts is $ Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 11. It is necessary or convenient that a guardian of the Person, Estate, Person and Estate be appointed because: 12. It is necessary that a temporary guardian be appointed in order to enroll the minor child in school and or obtain emergency medical treatment. (Delete if not requested) WHEREFORE, Petitioner requests appointment as Guardian of Person, Estate, Person and Estate of: . (Minor) CERTIFICATION Under penalties of perjury as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct. Date: , 20 Signature of Petitioner * - Any person who makes a false statement, material to the issue or point in questions, which he does not believe to be true, in any document certified by such person in accordance with 735 ILCS 5/1-109 shall be guilty of a Class 3 felony punishable by two (2) to five (5) years imprisonment and/or a $25,000.00 fine. Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 171P-31 (R 04/10)