PETITION FOR PROBATE OF WILL IN THE                                        COURT OF
THE STATE OF                                       ,                                        COUNTY

          IN THIS CAUSE, the undersigned respectfully submits the following Petition for the Conservatorship to be Established on behalf of                                        (name of person for whom the Conservatorship is designed):

          1.  It is the intention of the undersigned in conjunction with                                  (the individual for whom the Conservatorship is designed) to Establish this voluntary Conservatorship for the administration of the interest, property, financial matters, help and welfare of the individual for whom this Conservatorship is to be Established.

          2.  This Conservatorship is intended to be Established because the                                        (the individual for whom the Conservatorship is designed) is:

1. A minor;

2. The physical condition of the Ward is such that the Ward is unable to handle the Ward’s affairs;

3. The mental condition of the Ward is such that the Ward is unable to handle the Ward’s affairs;

4. It is anticipated that the Ward may not be capable, either mentally or physically, to handle the Ward’s own affairs as a result of a forthcoming event;

5. Other:                                       (explanation).

          3.  The undersigned individual is proposed as the Conservator for the aforementioned Ward and the full name of such Conservator is                                        and the complete address of the Conservator is                                                                              and the telephone number of the Conservator is                                       .

          4.  The undersigned proposed Conservator has known the Ward for         years and is related or knows the Ward from the following relationship:                                 (explanation of relationship).

          5.  The Ward is a resident of the State of                                       , is presently located at                                                                             , and is under the care of                                        (identify the individual or institution from whom or which the Ward is receiving care).

          6.  It is in the best interest of the Ward for there to be an appointment of Conservator and it is estimated that the Ward’s property has a worth of $               (see attached schedule of property identified as Schedule A).

          7.  The earnings per year of the Ward are $________, which are payable at                       (weekly, monthly, etc.) intervals.

          8.  Appropriate notice of this Petition/Application shall be served personally upon the Ward and shall also be mailed to the Ward at the following address:                                                                             .

          9.  The undersigned proposed Conservator agrees to be bound by all state laws regulating the administration of the Conservatorship and agrees further to file appropriate documentation and, if need be, consult from time to time with appropriate officers of the Court, including the undersigned attorney:

          WHEREFORE, the undersigned respectfully requests that the Court authorize the undersigned to act as the Conservator on behalf of the Ward and that the Court enter an appropriate Order.

          I,                                               (signatory as noted above), of                                                                 (address),                            (state) first duly sworn on oath depose and state that I have read the foregoing Petition/Application and state that the contents contained in the Petition/Application are true and correct to the best of my knowledge, information and belief.

          Subscribed and sworn to before me on this           day of                           ,           .