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1 Re: Suggestion of Need for Guardian or Need for Investigation of Circumstances under § 1102.001 - .003 of the Texas Estates Code NOTE: THIS IS NOT A CONFIDENTIAL DOCUMENT Date: Dear Judges: I hereby request the Court to investigate the need for a guardian for or the circumstances of the following person: Name: Address: Phone: Birthdate: County of residence: The primary reason I am requesting this investigation is (describe nature and degree of incapacity): This person is currently located in a: private residence health care facility hospital other (Address or Name) I am: Name (printed) Address: Daytime phone: Cell: E-mail: My relationship to the person for whom the investigation is requested: a family member (relationship) a social worker in a: hospital nursing home governmental facility a friend a doctor other ________________________________________________ Is the person in imminent danger of serious impairment of his or her physical health, safety, property, money or other assets? YES NO If "YES", please explain as best you can (attach a separate sheet if necessary):

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  • 1

    Re: Suggestion of Need for Guardian or Need for Investigation of Circumstances under § 1102.001 - .003 of the Texas Estates Code

    NOTE: THIS IS NOT A CONFIDENTIAL DOCUMENT Date:

    Dear Judges: I hereby request the Court to investigate the need for a guardian for or the circumstances of the following person:

    Name: Address:

    Phone: Birthdate:

    County of residence:

    The primary reason I am requesting this investigation is (describe nature and degree of incapacity):

    This person is currently located in a: private residence health care facility hospital other (Address or Name)

    I am: Name (printed) Address: Daytime phone: Cell: E-mail:

    My relationship to the person for whom the investigation is requested: a family member (relationship) a social worker in a: hospital nursing home governmental facility a friend a doctor other ________________________________________________

    Is the person in imminent danger of serious impairment of his or her physical health, safety, property, money or other assets? YES NO If "YES", please explain as best you can (attach a separate sheet if necessary):

  • 2

    To my knowledge, this person: YES NO is a resident of Harris County YES NO is located in Harris County YES NO has a Guardian in Texas. (Parents are the natural guardians of children under 18.) YES NO has executed a Power of Attorney. If “YES,” to whom was it given (answer

    below)?

    Agent’s Name: Relationship:

    Phone:

    Address: To my knowledge, this person is: YES NO able to provide food, clothing, or shelter for himself or herself. YES NO able to care for his or her own physical health. YES NO able to manage his or her own financial affairs.

    ASSETS

    The person has the following property: (real property, cash, bank accounts, certificates of deposit, stocks, securities, other investments, automobiles, etc. DO NOT LIST ACCOUNT NUMBERS)

    Description Value

    TOTAL

    INCOME MONTHLY INCOME: (Show sources and amounts per month. Attach additional sheets as needed.)

    Description Value Social Security (amount received per month) Veterans Benefits (amount received per month)

    Other monthly resources:

    TOTAL

  • 3

    Family Members: All immediate family members (spouse, children, parents, siblings), living or deceased, must be listed. Attach additional sheets as needed. Name: Relationship: Address:

    Living Deceased Age: YES NO Willing to serve as Guardian? Phone:

    Name: Relationship: Address:

    Name: Relationship: Address:

    Living Deceased Age: YES NO Willing to serve as Guardian? Phone:

    Name: Relationship: Address:

    Non-family members who might be willing to serve as guardian. Attach additional sheets as needed.

    Name: Relationship:

    Phone:

    Address:

    Name: Relationship:

    Phone:

    Address:

    Living Deceased Age: YES NO Willing to serve as Guardian? Phone:

    Living Deceased Age: YES NO Willing to serve as Guardian? Phone:

  • 4

    Generally, Texas Courts will not appoint a guardian if a “less restrictive alternative” (initials) is available. In that regard a list of less restrictive alternatives is attached to this form as

    an appendix. This is not intended to be an exclusive list, nor is it intended to substitute for the advice of legal counsel. However, you are requested to review this list, and indicate that you have done so by initialing the blank above and do not believe a less restrictive alternative is available.

    Sincerely, Signature Printed Name If you are a family member of the person believed to be incapacitated, you must complete the following section: It does not need to be notarized.

    DECLARATION

    "My name is and (First) (Middle) (Last)

    my address is .

    (Street & Apt #) (City) (State) (Zip Code) (Country)

    "I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge."

    Executed in County of , State of , on (date).

    Signature

    Revised November 1, 2019

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    Suggestion of Need Letter v2.1Less_Restrictive_Alternatives_to_Guardianship

    Date: Name 1: Name 2: Phone: Address: Birthdate: residence: The primary reason I am requesting this investigation is describe nature and degree of incapacity 1: The primary reason I am requesting this investigation is describe nature and degree of incapacity 2: The primary reason I am requesting this investigation is describe nature and degree of incapacity 3: private residence: Offhealth care facility: Offhospital: Offother Address or Name: OffThis person is currently located in a: Name printed: Address_2: Daytime phone: Cell: Email: My relationship to the person for whom the investigation is requested: a family member relationship: Offa social worker in a: Offhospital_2: Offnursing home: Offgovernmental facility: Offa friend: Offadoctor: Offother: Offundefined: money or other assets: OffIf YES please explain as best you can attach a separate sheet if necessary 1: If YES please explain as best you can attach a separate sheet if necessary 2: 1: 2: To my knowledge this person: Offundefined_2: Offbelow: Agents Name: Phone_2: Relationship: To my knowledge this person is: Offable to provide food clothing or shelter for himself or herself: OffDescription 1: Description 2: Description 3: Description 4: Description 5: Description 6: Description 7: Value 1: Value 2: Value 3: Value 4: Value 5: Value 6: Value 7: TOTAL: Value 1_2: Value 2_2: Value 3_2: Value 4_2: Other monthly resources 1: Other monthly resources 2: 1_2: 2_2: undefined_3: undefined_4: TOTAL_2: Name: Age: Relationship_2: Living: OffYES_9: OffDeceased: OffNO Willing to serve as Guardian: OffAddress 1: Address 2: Phone_3: Name_2: Age_2: Relationship_3: Living_2: OffYES_10: OffDeceased_2: OffNO Willing to serve as Guardian_2: OffAddress_3: Phone_4: undefined_5: Name_3: Age_3: Relationship_4: Deceased_3: OffNO Willing to serve as Guardian_3: OffAddress 1_2: Address 2_2: Living_3: OffYES_11: OffPhone_5: OffLiving_4: OffYES_12: OffPhone_6: Offundefined_6: Name_4: Age_4: Relationship_5: Deceased_4: OffNO Willing to serve as Guardian_4: OffAddress_4: undefined_7: undefined_8: Name_5: Phone_7: Relationship_6: Address_5: Name_6: Phone_8: Relationship_7: Address_6: initials: Printed Name: First: Middle: Last: Street Apt: City: State: Zip Code Country: Executed in County of: State of: