About
Our Firm
Paul Scott
Kelly Thompson
Jeff Zilinski
Douglas I. Buck II
Jessica Sharpe
Kraig Sippell
Kara D. Moore
Rachel Smith
Practice Areas
Personal Injury / Auto Accident
Criminal Defense
Family Law
DUI/OWI
Client Forms
Custody Intake
Criminal Defense Intake
Divorce Without Children Intake
Divorce With Children Intake
DUI/OWI Intake
Guardian Ad Litem Questionnaire
Blog
Media
Results
(810) 265-7161
Contact
Guardianship / Conservatorship
Background Information
Client Name(s)
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Washington DC
Armed Forces Africa/Canada/Europe/Middle East
Armed Forces America (Except Canada)
Armed Forces Pacific
Zip
Phone
Alt. Phone
Email Address
Ward's Name
Is there a Will or Power of Attorney currently in place? If yes, who was nominated as Guardian inthe Will or Power of Attorney?
If the Ward has a mental or physical incapacity or disability, please describe:
When did the Ward last see a medical professional regarding the above referenced incapacity ordisability?
Did you obtain a written report from the medical professional?
Are you able to pass a criminal background check and central registry check (Note that thoseseeking to be nominated in this role must submit to such):
Ward's Family
Spouse's Name (First/Middle/Last)
Address
Phone Number
Living or Deceased
Children
Full Name(s) (First/Middle/Last)
Address
Phone Number(s) (if applicable)
Parent(s)
Parent's Name (First/Middle/Last)
Address
Phone Number
Living or Deceased
Ward's Financial Information (For conservatorship only):
Real Estate
Address
Owner(s)
Value
Banks/Financial Institutions (Checking, Savings, Money Market, Stock, etc.)
Entity
Account Type
Owner(s)
Value
Qualified Accounts (401Ks, Roths, IRA, etc.)
Entity
Account Type
Owner(s)
Value
Life Insurance Policies
Entity
Policy Type
Owner(s)
Value
Other (Vehicles, Expensive Jewelry, 529 Plans, Crypto, etc.)
Entity
Account/Policy Type
Owner(s)
Value
Liabilities (Mortgage, Car Loan, Credit Card Debt, Judgment, Lien, Medicaid Repayment, etc.)
Entity
Type
Debtor(s)
Value
ReCaptcha
PDF Version
Estate Planning Intake
Post Judgement Intake
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