Guardianship Interview Form

Your Name (required)

Your Email (required)

Your Contact Phone Number (required)

Your Street Address (required)

Your City (required)

Your State (required)

Your Zip Code (required)

Referred By (If referred by a person, is this a client or attorney? If you heard about this law office by the internet, which search engine? What search terms did you use?)

The following questions will be in regards to the person in which you seek guardianship for

Name of person for whom you seek Guardianship (required)

Current street address for incapacitated person whom Guardianship is sought (required)

Current city for incapacitated person whom Guardianship is sought (required)

Current state for incapacitated person whom Guardianship is sought (required)

Current zip code for incapacitated person whom Guardianship is sought (required)

Current phone number for incapacitated person whom Guardianship is sought (required)

Your Relationship to Person

Their Date of Birth

The other kin 1 of Incapacitated Person
Relationship Residing at

The other kin 2 of Incapacitated Person
Relationship Residing at

The other kin 3 of Incapacitated Person
Relationship Residing at

Doctor 1 who will sign Affidavit that person is incapacitated Name address phone number and fax number

Doctor 2 who will sign Affidavit that person is incapacitated Name address phone number and fax number

Is there a will?  Yes No

Did you bring a copy of the will?  Yes No

Is there a Power of Attorney?  Yes No

Did you bring a copy of the Power of Attorney?  Yes No

Do you have a copy of the Deed?  Yes No

Asset Section

The court rules require details of assets be set forth in a Guardianship case.

SCHEDULE A: REAL PROPERTY If none, check none and skip to the SCHEDULE B

 Yes to real property None

Property number and street address

Property town

Property Lot

Property Block

Property County

Property Title Owner of Record

Tax Assessor Assessed Value $

Full Market Value of Property $

Mortgage Balance $

Any other Real Estate $

SCHEDULE B: BANK ACCOUNTS, STOCK, CD, OTHER ASSETS If none, enter none in each box

All Other Personal Property Owned Individually or Jointly; Market Value, Indicate the Manner of Registration at Date of Death

1st Bank Accounts/ Brokerage Accounts - Name of Bank, Acct. #

1st Account Balance $

2nd Bank Accounts/ Brokerage Accounts - Name of Bank, Acct. #

2nd Account Balance $

3rd Bank Accounts/ Brokerage Accounts - Name of Bank, Acct. #

3rd Account Balance $

4th Bank Accounts/ Brokerage Accounts - Name of Bank, Acct. #

4th Account Balance $

Name of Stock Company and Account Number

Stock Balance $

Name of Stock Company and Account Number

Stock Balance $

Name of Stock Company and Account Number

Stock Balance $

Investment Bonds and Account Number

Bond Balance $

Investment Bonds and Account Number

Bond Balance $

Vehicle One

Vehicle Value $

Vehicles Two

Vehicle Value $

Vehicles Three

Vehicle Value $

Other Assets Over $10,000

Other Assets Value $

Other Assets Over $10,000

Other Assets Value $

Other Assets Over $10,000

Other Assets Value $

Other Assets Over $10,000

Other Assets Value $

Liabilities over $2,000

Liabilities over $2,000

Estimated Gross Estate $

Additional Information

Set forth several specific acts of incompetency by the alleged incapacitated person

Please use the following section to ask your specific questions for the attorney