CIRCUIT ORPHANS' COURT FOR , MARYLAND
City/County
Located at Case No.
Court Address
Name of Minor Docket Reference
PETITION FOR GUARDIANSHIP OF MINOR
(Md. Rule 10-111)
Note: This form is to be used where the only ground for the petition is minority.
Guardianship Guardianship Guardianship of
of Person of Property Person and Property
The petitioner, , whose
Name Age
address is ,
and whose telephone number is , represents to the court that:
1. The minor , ,
Age
born on the day of , ,a male or female child of
Month Year
and
,
resides at .
A birth certificate of the minor is attached.
2. If the minor does not reside in the county in which this petition is filed, state the place in this
county where the minor is currently located
.
NOTE: For purposes of this Form, "county" includes Baltimore City.
3. The relationship of petitioner to the minor is
.
4. The minor
is a beneficiary of the Veterans Administration and the guardian may expect to receive
benefits from that Administration.
is not a beneficiary of the Veterans Administration.
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5. Complete Section 5. if the petitioner is asking the court to appoint the petitioner as the guardian.
(Check only one of the following boxes)
I have not been convicted of a crime listed in Code, Estates and Trusts Article, §11-114.
I was convicted of such a crime, namely
. The conviction occurred in
, in the ,
Year Name of Court
but the following good cause exists for me to be appointed as guardian:
.
6. Complete Section 6. if the petitioner is asking the court to appoint an individual other than the
petitioner as the guardian.
6 a. Prospective Guardian of the Person (Complete section 6 a. if seeking guardianship of the person.)
The name of the prospective guardian of the person is and
that individual's age is . The relationship of that individual to the minor is
(Check only one of the following boxes)
has not been convicted of a crime listed
Name of Prospective Guardian
in Code, Estates and Trusts Article, §11-114.
was convicted of such a crime, namely
Name of Prospective Guardian
. The conviction occurred in , in the
Year
, but the following good cause exists for
Name of Court
the individual to be appointed as guardian:
.
6 b. Prospective Guardian of the Property (Complete section 6 b. if the prospective guardian of the
property is different from the prospective guardian of the person or if guardianship of the person is not
sought.) The name of the prospective guardian of the property is
and that individual's age is . The relationship of that individual to the minor is .
(Check only one of the following boxes)
has not been convicted of a crime listed in Code,
Name of Prospective Guardian
Estates and Trusts Article, §11-114.
was convicted of such a crime, namely
Name of Prospective Guardian
. The conviction occurred in , in the
Year
, but the following good cause exists for
Name of Court
the individual to be appointed as guardian:
.
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7. State the name and address of any additional person on whom service shall be made on behalf of
the minor, including a minor who is at least 10 years of age:
.
8. The following is a list of the names, addresses, and telephone numbers, and e-mail addresses, if
known, of all interested persons (see Code, Estates and Trusts Article, §13-101(k)).
List of Interested Persons
Parents:
Name Address Telephone Number E-mail Address (if known)
Name Address Telephone Number E-mail Address (if known)
Siblings:
Name Address Telephone Number E-mail Address (if known)
Name Address Telephone Number E-mail Address (if known)
Name Address Telephone Number E-mail Address (if known)
Name Address Telephone Number E-mail Address (if known)
Any Other Heirs at Law:
Name Address Telephone Number E-mail Address (if known)
Guardian (if appointed):
Name Address Telephone Number E-mail Address (if known)
Any Person Holding a Power of Attorney of the Minor:
Name Address Telephone Number E-mail Address (if known)
Minor's Attorney:
Name Address Telephone Number E-mail Address (if known)
Any Other Person Having Assumed Responsibility for the Minor:
Name Address Telephone Number E-mail Address (if known)
Any Government Agency Paying Benefits to or for the Minor:
Name Address Telephone Number E-mail Address (if known)
Any Person Having an Interest in the Property of the Minor:
Name Address Telephone Number E-mail Address (if known)
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All Other Persons Exercising Control over the Minor or the Minor's Property:
Name Address Telephone Number E-mail Address (if known)
A Person or Agency Eligible to Serve as Guardian of the Person of the Minor:
Name Address Telephone Number E-mail Address (if known)
9. The names and addresses of the persons with whom the minor resided over the past five years,
and the approximate dates of the minor's residence with each person are, as follows:
Names Addresses Approximate Dates
10. Guardianship is sought for the following reason(s):
.
11. If this Petition is for Guardianship of the Property, the following is the list of all the property in
which the minor has any interest including an absolute interest, a joint interest, or an interest less than
absolute (e.g. trust, life estate). Sole Owner, Joint Owner,
(specific type), Life
Tenant, Trustee,
Property Location Value Custodian, Agent, etc.
12. The petitioner's interest in the property of the minor listed in 11. is
.
13. (a) All other proceedings regarding the minor (including any proceedings in juvenile court) are,
as follows:
.
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(b) All proceedings regarding the petitioner and prospective guardian filed in this court or any
other court are, as follows:
.
14. All exhibits required by the Instructions below are attached.
WHEREFORE, Petitioner requests that this court issue an order to direct all interested persons to
show cause why a guardian of the person property person and property of the minor should
not be appointed, and (if applicable) should not be appointed
Name of Prospective Guardian
as the guardian.
Attorney's Signature Date Petitioner's Name
Attorney's Name
Address
City, State, Zip Telephone Number
E-mail Fax
Petitioner solemnly affirms under the penalties of perjury that the contents of this document are true
to the best of Petitioner's knowledge, information, and belief.
Date Petitioner's Name
Petitioner's Signature
INSTRUCTIONS
1. The required exhibits are as follows:
(a) A copy of any instrument nominating a guardian [Code, Estates and Trusts Article, §13-701 and
Maryland Rule 10-301(d)];
(b) If the petition is for the appointment of a guardian for a minor who is a beneficiary of the
Department of Veterans Affairs, a certificate of the Administrator or the Administrator's authorized
representative, setting forth the age of the minor as shown by the records of the Veterans Administration,
and the fact that appointment of a guardian is a condition precedent to the payment of any moneys due the
minor from the Veterans Administration shall be prima facie evidence of the necessity for the appointment
[Code, Estates and Trusts Article, §13-802 and Maryland Rule 10-301(d)].
2. Attach additional sheets to answer all the information requested in this petition, if necessary.
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