City, State, Zip 

 
Name 

 
Address 

 
Phone 

 
Email  

 

This is a tier 2 case. 

 

If you do not respond to this 
document within applicable time 
limits, judgment could be entered 
against you as requested. 

 
 
 
 
 
Check your email. You will receive information and 
documents at this email address.  
 

I am   [  ]  Petitioner 

[  ]  Petitioner’s Attorney 

 
  (Utah Bar #:__________) 

In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the Matter of Protection for 

___________________________________, 
Respondent 

_______________________________ 
Case Number 

Petition to Appoint a Guardian for an 
Adult 

[  ]  Attorney for the respondent 

requested 

[  ]  Court visitor requested 

_______________________________ 
Judge 

I request that the court appoint ___________________________________ (name 
of proposed guardian), who is a competent person or suitable institution, as guardian  

for ______________________________________________ (name of respondent). 

The court has jurisdiction under Utah Code 75-1-302. 

The court has venue because the respondent resides or is present in this county. 

1. 

2. 

3. 

 

Petition to Appoint a Guardian for an Adult 

Page 1 of 9 

 

Approved Board of District Court Judges 
September 12, 2012 / Revised by Forms 
Committee April 11, 2022  
 

4. 

The interested persons who must be served are described in Schedule A, which 
is attached. Service of a copy of this petition and notice of the time and place of 
the hearing will occur as described in Schedule A. 

5. 

Information about the respondent: 

6. 

Information about the proposed guardian: 

ame 

ddress 

hone 

mail 

ity, State, Zip 

ocial Security Number 

ate of Birth 

river License Number 

ame 

ddress 

hone 

mail 

ity, State, Zip 

ocial Security Number 

ate of Birth 

river License Number 

  N

  A

  C

  P

  E

  S

  D

  D

  N

  A

  C

  P

  E

  S

  D

  D

7. 

Information about the proposed guardian’s next of kin or other contact person: 
 

Petition to Appoint a Guardian for an Adult 

Page 2 of 9 

Approved Board of District Court Judges 
September 12, 2012 / Revised by Forms 
Committee April 11, 2022  
 

8. 

The proposed guardian has priority for appointment because they: (Choose all that 
apply.) 

[  ]  have been nominated by the respondent (Choose one.) 

[  ]  in a signed writing substantially conforming to the requirements of Utah 

Code 75-5-311. 

[  ] by some means other than a signed writing substantially conforming to the 

requirements of Utah Code 75-5-311. 

[  ]  are the respondent’s spouse. 

[  ]  are the respondent’s adult child. 

[  ]  are the respondent’s parent. 

deceased spouse. 

deceased parent. 

[  ]  are a person nominated by will or other writing signed by the respondent’s 

[  ]  are a person nominated by will or other writing signed by the respondent’s 

[  ]  are the respondent’s relative with whom the respondent has resided for more 

than six months before the filing of the petition. 

[  ]  have been nominated by ____________________________________ (name) 

who is caring for the respondent or paying benefits to the respondent. 

[  ]  are a specialized care professional who does not profit financially or 

otherwise from or receive compensation for acting as guardian, except for the 
direct costs of providing guardianship services, and does not otherwise have 
a conflict of interest in providing those services. 

[  ]  are the Office of Public Guardian. 

[  ]  had a court order granting sole legal decision making authority over the 

respondent when respondent turned 17 years and six months old, and this 
petition is being filed within 2 years after the day respondent turns 18. The 
case number is  ________________________. 

Approved Board of District Court Judges 
September 12, 2012 / Revised by Forms 
Committee April 11, 2022  
 

Petition to Appoint a Guardian for an Adult 

Page 3 of 9 

ity, State, Zip 

Name 

ddress 

hone 

mail 

  A

  C

  P

  E

[  ]  are the respondent’s parents, or two people who share joint legal decision-

making authority over the respondent.  

[  ]  are __________________________________________________________ 

(describe relationship to the respondent) 

9. 

___________________________________________________ (name) has been 
nominated as guardian for the respondent but is not the proposed guardian. (If no 
one or the proposed guardian has been nominated, enter “no one.”) The nomination was 
made by: (Choose all that apply.) 

[  ]  the respondent; 

[  ]  the respondent’s spouse; 

[  ]  the respondent’s parent; 

[  ]  the respondent’s caregiver. 

10. 

The court should appoint the proposed guardian because: (Choose one.) 

[  ]  the proposed guardian is highest in priority established by statute. 

[  ]  there is good cause not to follow the statutory priority because: 

11. 

List any other guardianship or conservatorship orders or pending cases 
regarding the respondent. (If there are no other orders or proceedings, enter “none.”) 

       

       

12. 

The respondent’s ability to: 

[  ]  receive and evaluate information; or 
[  ]  make and communicate decisions; or 
[  ]  provide for necessities such as food, shelter, clothing, health care, or safety 

is impaired to the extent that they lack the ability, even with appropriate 
technological assistance, to meet the essential requirements for financial 
protection or physical health, safety, or self-care. 

Approved Board of District Court Judges 
September 12, 2012 / Revised by Forms 
Committee April 11, 2022  
 

Petition to Appoint a Guardian for an Adult 

Page 4 of 9 

13. 

The respondent has the following functional limitations, and a guardian is 
necessary or desirable as a means of providing the respondent with continuing 
care and supervision: 

14. 

[  ]  A report about the respondent, written by a physician or psychologist, is 

 

 

attached.   
(Only required if respondent is a minor. Utah Code 75-5-317.) 

[  ]  The report is based on an evaluation done in the last six months. I ask 

the court to waive any additional evaluation. 

15. 

The respondent’s incapacity is proved by the following clear and convincing 
evidence: (Describe examples of the respondent’s inabilities and functional limitations, so that, 
even with appropriate technological assistance, they unable to meet the essential requirements 
for financial protection or physical health, safety, or self-care. Attach supporting documents, 
including statements of any witnesses who are familiar with the respondent and/or evaluations of 
respondent’s physician or other evaluator.) 

16.  A guardianship is necessary or desirable as a means of providing the respondent 

with continuing care and supervision because: 
(Explain what alternatives other than a guardianship have been tried and why they did not 
succeed. Or explain why alternatives have not been tried.) 

Approved Board of District Court Judges 
September 12, 2012 / Revised by Forms 
Committee April 11, 2022  
 

Petition to Appoint a Guardian for an Adult 

Page 5 of 9 

         

                 

     

Choose paragraph 17 or 18, but not both. 

17. 

[  ]  Limited guardianship. The respondent requires a guardian with limited 

authority to: (Choose all that apply.) 

[  ]  make decisions about the respondent’s custody and residence; 

[  ]  make decisions about the respondent’s training and education; 

[  ] provide for the respondent’s care, comfort, and maintenance; 

[  ] take reasonable care of the respondent’s clothing, furniture, vehicles, 

and other personal effects; 

[  ] commence protective proceedings if the respondent’s property needs 

protection; 

[  ] give consent necessary to enable the respondent to receive medical or 

other professional care, counsel, treatment, or service, 

__________________________________ (name) should be notified 
if the respondent receives significant health care or treatment; 

[  ] institute proceedings to compel a person to perform their duty to support 

the respondent; 

[  ] receive money and tangible property deliverable to the respondent and 
apply the money and property for the respondent’s support, care, and 
education;  

[  ] other (Describe additional authority that the guardian should have.) 

18. 

Full guardianship.   __________________________________ 

[  ]   
(name) should be notified if the respondent receives significant health care 
or treatment; 

Approved Board of District Court Judges 
September 12, 2012 / Revised by Forms 
Committee April 11, 2022  
 

Petition to Appoint a Guardian for an Adult 

Page 6 of 9 

         

       

  

 

The respondent requires a guardian with plenary or full authority because: 
(Explain why nothing less than a full guardianship is adequate to provide the respondent 
with continuing care and supervision.) 

             

19. 

The estimated value of the respondent’s assets is: (Attach additional pages if needed. 
Refer to paragraph 19.) 

General Description 

Estimated Value 

Unknown 

 20.  The respondent’s estimated monthly income from all sources is: (Attach additional 

pages if needed. Refer to paragraph 20.) 

General Description 

Estimated Value 

Unknown 

Home and other real estate 

Bank and credit union accounts 

Investments 

Personal property 

Other 

Home and other real estate 

Bank and credit union accounts 

Investments 

Personal property 

Other 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 
Total  $ 

$ 
Total  $ 

[  ] 

[  ] 

[  ] 

[  ] 

[  ] 

[  ] 

[  ] 

[  ] 

[  ] 

[  ] 

[  ] 

[  ] 

21. 

The respondent: (Choose one.) 

[  ] will be represented by _____________________________________, (name) 

an attorney selected by the respondent. 

Approved Board of District Court Judges 
September 12, 2012 / Revised by Forms 
Committee April 11, 2022  
 

Petition to Appoint a Guardian for an Adult 

Page 7 of 9 

[  ] needs an attorney appointed by the court, and I am filing with this petition a 

Request to Appoint an Attorney. 

22. 

The respondent: (Choose one.) 

[  ]  will be present at the hearing. 

[  ] should be excused from attending the hearing: (Choose one.) 

[  ]  and I am filing with this petition a Request to Assign a Court Visitor to 
inquire about whether to excuse the respondent from attending the 
hearing under Utah Code 75-5-303. 

[  ]  because of clear and convincing evidence from a physician that the 

respondent has: (Choose all that apply. Attach physician’s affidavit.) 

[  ]  fourth stage Alzheimer's disease; 

[  ]  extended comatosis; and/or 

[  ]  an intellectual disability with an IQ score under 20 to 25. 

23. 

I request that the court: 
  schedule a hearing on this petition; 
  give notice as required by Utah Code Section 75-5-309; 
  enter an order declaring the respondent to be an incapacitated person and  

appointing ______________________________________ (name) as guardian 
with the authority requested in paragraph 17 or 18, to serve: (Choose one.) 

[  ]  without bond. 

[  ]  with bond in the amount of $___________. 

 

issue a Letter of Guardianship to the guardian describing the guardian’s 
authority. 

24. 

[  ] 

I ask the court to make the order immediately effective upon the 

 

respondent's 18th birthday, which is __________________________ (date). 

 declare under criminal penalty under the law of Utah that everything stated in this document is true. 

Signed at ______________________________________________________ (city, and state or country). 

Signature ► 

 

Petition to Appoint a Guardian for an Adult 

Page 8 of 9 

Approved Board of District Court Judges 
September 12, 2012 / Revised by Forms 
Committee April 11, 2022  
 

 

    I

 

Date 

 

Printed Name 

 

Approved Board of District Court Judges 
September 12, 2012 / Revised by Forms 
Committee April 11, 2022  
 

Petition to Appoint a Guardian for an Adult 

Page 9 of 9