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Guardianship Registry Information Sheet(? Individual ? Estate ? Estate and Individual)Choose One* (? Minor ? Adult) Choose One*(? Temporary ? Permanent)Related Cases (List any cases in which the Protected Person is a party, e.g., CHINS)___________________________ ___________________________ __________________________PetitionerRelationship to Protected Person* ______________________________Last:*______________________ Suffix:_____ First:*____________________ Middle:_____________DOB:_______________ Gender:*_____ Race:*___________________________ Hispanic?: Yes/NoAddress:*_____________________________________________________________________________Home Phone:_________________ Work Phone:_________________ Cell Phone:__________________Email Address:*_______________________________________________________________________Attorney Name:____________________ Bar Number:___________ App. Filed Date: _______________Protected PersonEstimated Value $___________Last:*______________________ Suffix:_____ First:*____________________ Middle:_____________DOB:*______________ Gender:*_____ Race:*___________________________ Hispanic?: Yes/NoEye Color:__________ Hair Color:__________ Height:__________ Weight:__________ lbsScars, Marks, and Tattoos: _______________________________________________________________Address:*_____________________________________________________________________________Home Phone:_________________ Work Phone:_________________ Cell Phone:__________________Email Address:_________________________________________________________________________Attorney Name:____________________ Bar Number:___________ App. Filed Date: _______________Guardian Ad Litem Full Name:____________________________________________________________Interpreter required? Yes/No Language: ___________Guardian ? Check if same as petitioner ? Certified (Only check if Federal or State Certified)Last:*______________________ Suffix:_____ First:*____________________ Middle:_____________DOB:_______________ Gender:*_____ Race:*___________________________ Hispanic?: Yes/NoAddress:*_____________________________________________________________________________Home Phone:_________________ Work Phone:_________________ Cell Phone:__________________Email Address:*_______________________________________________________________________Attorney Name:____________________ Bar Number:___________ App. Filed Date: _______________Guardian InstitutionName:*______________________________________________________________________________Address:*_____________________________________________________________________________Phone:_________________ Fax:_________________ Agent Name:_____________________________Close Relative (Entitled to Notice)Relationship to Protected Person ________________________Last:*______________________ Suffix:_____ First:*____________________ Middle:_____________Gender:*_____ Race:*___________ Hispanic?: Yes/NoMailing Address:*______________________________________________________________________Home Phone:_________________ Work Phone:_________________ Cell Phone:__________________Email Address:_________________________________________________________________________Guardianship Registry Information Sheet(Additional)PetitionerRelationship to Protected Person ________________________Last:*______________________ Suffix:_____ First:*____________________ Middle:_____________DOB:_______________ Gender:*_____ Race:*___________________________ Hispanic?: Yes/NoAddress:*_____________________________________________________________________________Home Phone:_________________ Work Phone:_________________ Cell Phone:__________________Email Address:_________________________________________________________________________Attorney Name:____________________ Bar Number:___________ App. Filed Date: _______________Guardian ? Check if same as petitioner ? Certified (Only check if Federal or State Certified)Last:*______________________ Suffix:_____ First:*____________________ Middle:_____________DOB:_______________ Gender:*_____ Race:*___________________________ Hispanic?: Yes/NoAddress:*_____________________________________________________________________________Home Phone:_________________ Work Phone:_________________ Cell Phone:__________________Email Address:_________________________________________________________________________Attorney Name:____________________ Bar Number:___________ App. Filed Date: _______________Close Relative (Entitled to Notice)Relationship to Protected Person ________________________Last:*______________________ Suffix:_____ First:*____________________ Middle:_____________Gender:*_____ Race:*___________ Hispanic?: Yes/NoMailing Address:*______________________________________________________________________Home Phone:_________________ Work Phone:_________________ Cell Phone:__________________Email Address:_________________________________________________________________________Interested PartyLast:*______________________ Suffix:_____ First:*____________________ Middle:_____________Gender:*_____ Race:*___________ Hispanic?: Yes/NoAddress:*_____________________________________________________________________________Home Phone:_________________ Work Phone:_________________ Cell Phone:__________________Email Address:_________________________________________________________________________Interested PartyLast:*______________________ Suffix:_____ First:*____________________ Middle:_____________Gender:*_____ Race:*___________ Hispanic?: Yes/NoAddress:*_____________________________________________________________________________Home Phone:_________________ Work Phone:_________________ Cell Phone:__________________Email Address:_________________________________________________________________________ ................
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