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Here is the text we could read:

 
Name 
 
Address 
 
City, State, Zip 
 
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 

Petition to Appoint a Conservator 
for an Adult 

___________________________________ 
Respondent 

_______________________________ 
Case Number 

_______________________________ 
Judge 

1. 

I request that the court appoint ___________________________________ (name  

of proposed conservator) as conservator for  

_________________________________________________ (name of respondent). 

The petitioner is interested in the respondent’s estate, affairs, or welfare, or 
would be adversely affected by lack of effective management of the respondent’s 
property and affairs. 

The court has jurisdiction under Section 75-1-302 and Section 75-5-402. 

The court has venue because the respondent: (Choose one.) 

[  ]  resides in this county; 

[  ]  does not reside in this state but has property in this county. 

Petition to Appoint a Conservator for an Adult 

Approved Board of District Court Judges December 14, 2012 
Revised February 8, 2021 

Page 1 of 6 

2. 

3. 

4. 

 

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

The conservator proposed in this petition is: (Choose all that apply. Attach a complete, 
legible copy of any nomination or court order checked below.) 

[  ]   already appointed by another court to care for the respondent’s affairs. 

[  ]   nominated in writing by another person already appointed by a court to care 

for the respondent’s affairs. 

[  ]    nominated by the respondent, who is at least 14 years of age and has 

sufficient mental capacity to make an intelligent choice. This nomination was 
made in writing or by some other method conforming to the requirements of 
Utah Code Section 75-5-410. 

[  ]    the respondent’s spouse or a person nominated in writing by the 

respondent’s spouse. 

[  ]    the respondent’s adult child or a person nominated in writing by the 

respondent’s adult child. 

[  ]    the respondent’s parent. 

[  ]    nominated in the will of the respondent’s deceased parent or someone 

chosen by the person nominated in the will. 

[  ]    a relative with whom the respondent has resided for more than six months 
before this petition was filed, or someone nominated by that relative. 

[  ]    a person nominated by whoever is caring for or paying benefits to the 

respondent. 

[  ]    is __________________________________________________________. 

(describe any other relationship to the respondent) 

_________________________________________________________ (name) is 
a person with power of attorney for the respondent. (If no one has power of attorney for 
the respondent, enter “no one.”) 

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

Petition to Appoint a Conservator for an Adult 

Approved Board of District Court Judges December 14, 2012 
Revised February 8, 2021 

Page 2 of 6 

7. 

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

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

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

   

5. 

6. 

8. 

9. 

 

11. 

Information about the respondent’s nearest relative known to me: 

12. 

Information about the respondent’s guardian: 

Petition to Appoint a Conservator for an Adult 

Approved Board of District Court Judges December 14, 2012 
Revised February 8, 2021 

Page 3 of 6 

 

10. 

Information about the respondent: 

ame 

ddress 

hone 

mail 

ity, State, Zip 

ocial Security Number 

ate of Birth 

river License Number 

ity, State, Zip 

ame 

ddress 

hone 

mail 

ame 

ddress 

ity, State, Zip 

hone 

     

  N

  A

  C

  P

  E

  S

  D

  D

  N

  A

  C

  P

  E

  N

  A

  C

  P

14. 

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

15. 

The estimated value of the respondent’s assets is: (Attach additional pages if needed. 
Refer to Paragraph (18).) 

General Description 

Estimated Value 

Home and other real estate 

Bank and credit union accounts  $ 

Investments 

Personal property 

$ 

$ 

$ 

Unknown 
[  ] 

[  ] 

[  ] 

[  ] 

Petition to Appoint a Conservator for an Adult 

Approved Board of District Court Judges December 14, 2012 
Revised February 8, 2021 

Page 4 of 6 

 

13. 

Information about the proposed conservator: 

mail 

ame 

ddress 

hone 

mail 

ity, State, Zip 

ame 

ddress 

hone 

mail 

ity, State, Zip 

  E

  N

  A

  C

  P

  E

  S

  D

  D

  N

  A

  C

  P

  E

ocial Security Number 

ate of Birth 

river License Number 

General Description 

Estimated Value 

Unknown 

Other: 

16. 

The respondent’s estimated monthly income from all sources is:  
(Attach additional pages if needed. Refer to Paragraph (19).) 

General Description 

Social Security benefits 

Estimated Monthly 
Amount 

Unknown 
[  ] 

Pension 

Interest 
Other: 

$ 

Total  $ 

$ 

$ 

$ 

$ 

Total  $ 

[  ] 
[  ] 

[  ] 

[  ] 

[  ] 
[  ] 

17. 

The respondent is unable to manage his/her property and affairs effectively 
because of: (Choose all that apply.) 

[  ]  mental illness 

[  ]  mental deficiency 

[  ]  physical illness 

[  ]  physical disability 

[  ]  advanced age 

[  ]  chronic use of drugs 

[  ]  chronic intoxication 

18. 

(Choose one or both.) 

management. 

[  ]  confinement 

[  ]  detention by a foreign power 

[  ]  disappearance 

[  ]  other (describe) ______________ 
__________________________
__________________________
__________________________
__________________________ 

[  ]    The respondent has property which will be harmed without proper 

Petition to Appoint a Conservator for an Adult 

Approved Board of District Court Judges December 14, 2012 
Revised February 8, 2021 

Page 5 of 6 

 

[  ]    Funds are needed for the respondent’s welfare or those entitled to be 

supported by the respondent and a conservatorship is necessary to obtain 
or provide funds. 

19. 

The basis for an appointment is shown by following evidence:  
(Describe the reasons causing the inability to effectively manage property and affairs claimed in 
paragraph (19). Describe how the respondent’s property is being harmed or who is entitled to 
support but not receiving it. Attach supporting documents, including statements of any witnesses 
who are familiar with the respondent and/or evaluations of respondent’s physician or other 
evaluator.) 

20. 

I request that the court: 

  schedule a hearing on this petition; 

  give notice as required by Utah Code Section 75-5-405; 

  enter an order appointing ____________________________________ (name) 

as conservator to serve: (Choose one.) 

[  ]  without bond; 

[  ]  with bond in the amount of $___________; 

  grant to the conservator the authority allowed by Section 75-5-408; 

 

issue a Letter of Conservatorship to the conservator describing the 
conservator’s authority. 

 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 ► 

Printed Name 

 

 

Petition to Appoint a Conservator for an Adult 

Approved Board of District Court Judges December 14, 2012 
Revised February 8, 2021 

Page 6 of 6 

             

  I

 

 

 
Date

Petition to Appoint a Conservator for an Adult

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from legacy.utcourts.gov (2023-03)
Page(s): 6
Fields(s): 189
Average fields per page: 31
Reading Level: Grade 11
LIST Grouping(s): GO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

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We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

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users1_address_line_one
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users1_phone_number
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district_court_utah
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petition_appoint_conservator
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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Petition to Appoint a Conservator for an Adult

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02