(A) Enter the name of the individual who you believe needs a conservator.
(B) Enter your name in the first line. Enter your relationship to the individual (or your interest) in the second line.
(C) Enter the date the individual was born; what county the individual is a resident of; the address of the place where the individual normally lives, and the county the individual's property is in.
(D) Check this box if there is or has been a case in the family division of the circuit court involving the individual in (A). Examples of a family division case are personal protection, abuse or neglect, or a name change. If you have checked this box, enter the name of the court, the case number of the action, the name of the judge assigned to that case. Then place a check in the box indicating whether that case is still pending or not.
(E) Check the boxes that apply and provide the name(s) and address(es). If the individual has a power of attorney and you have a copy of the document, make a copy for the court.
(F) Check the boxes that you believe apply to the individual.
(G) Explain in as much detail as possible the specific facts about the individual's conduct or condition that lead you to believe he or she needs a conservator. Give specific examples of his or her conduct that supports what you checked in (F) and that demonstrate the need for a conservator. This information is extremely important for the court in making a decision about the need to appoint a conservator. If you are the guardian asking for authority to sell or otherwise dispose of your ward's real property, state the reasons why it is in the ward's best interest to do so.
(H) Specify the approximate value of any real property, personal property, insurance, and monthly income of the individual. An example of real property is a house. Examples of personal property are home furnishings, bank accounts, and checking accounts.
Check whether the individual is currently receiving benefits from governmental agencies and the amount(s).
(J) - (K)
Check all the boxes that apply and enter the names, relationships, addresses and telephone numbers of each relative of the individual. If any of the adults named in (J) are under legal incapacity, enter the names in (K).
(L) Enter the address where the individual is currently located. This address may or may not be the home of the individual. For example, if the individual is currently in the hospital, enter the name and address of the hospital.
(M) If there is an emergency that requires that a preliminary protective order be entered before the hearing, enter the reason(s).
(N) Enter the name, address, and telephone number of the person you want to be appointed as conservator of the individual. Enter the relationship, if any, that this person has to the individual. If you are the guardian asking for authority to sell or otherwise dispose of your ward's real property, leave this blank and complete.
(O) Check this box only if you checked (M).
(P) Check this box if you want the individual's property protected but you do not want a conservator appointed.
(Q) Check this box if you want the guardian appointed special conservator to dispose of real property.
(R) Enter today's date, sign your name, and enter your address and telephone number.
If the individual wants to nominate someone to be the conservator, check the box and enter the name, address, and telephone number of the person the individual is nominating. The individual must sign and date the form.