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Page 1 of 3 Petition for Appointment of Guardian for a Minor 01/29/2013 ELEVENTH JUDICIAL CIRCUIT COURT McLEAN COUNTY, IL In the Matter of the Estate of: Case Number: , a minor. PETITION FOR APPOINTMENT OF GUARDIAN FOR A MINOR a reputable citizen of Illinois, hereby certifies: (Petitioner) 1. Petitioner resides at: (Address of Petitioner) 2. Petitioner is a(n) to the minor. (Relationship to Minor) 3. The following minor child is in need of a guardian: (Name of Minor) (Minor’s Date of Birth) (Current Address of Minor) (Minor’s County of Residence) 4. The names and post office address of the biological parents of the minor are: (Name of Mother) (Address) (Name of Father) (Address) 5. If one or both of the biological parents of the minor are no longer living, attach death certificate(s) and list the minor’s next closest relatives: (Name) (Relationship) (Address) (Name) (Relationship) (Address) (Name) (Relationship) (Address) (Name) (Relationship) (Address) ---PAGE BREAK--- Page 2 of 3 Petition for Appointment of Guardian for a Minor 01/29/2013 6. The minor currently resides with at (Name) and has so resided since (Address) (Date) 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, and is employed as (Occupation) 9. Has Petitioner ever been convicted of a felony? Yes No If yes, describe the nature, date, and circumstances of the offense: 10. Petitioner is qualified and willing to act as guardian of the: person, estate, person and estate, of the minor. 11. The approximate value of the minor’s personal estate is 12. The amount of current/anticipated gross annual income, financial assistance, and other receipts is 13. It is necessary or convenient that a guardian of the person, estate, person and estate, be appointed because: 14. It is necessary that a temporary guardian be appointed in order to enroll the minor child in school and/or obtain emergency medical treatment. (Strike if not requested.) ---PAGE BREAK--- Page 3 of 3 Petition for Appointment of Guardian for a Minor 01/29/2013 WHEREFORE, Petitioner requests appointment as Guardian of the person, estate, person and estate, of: (Name 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) (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 to five years imprisonment and/or a $25,000 fine. NOMINATION I, a minor over 14 years of age, nominate as guardian of (Name) my person, estate, person and estate, and as (Name) guardian of my person, estate. (Date) (Signature of Minor)