IN THE DISTRICT COURT OF THE FIRST JUDICIAL DISTRICT OF THE

STATE OF IDAHO, IN AND FOR THE COUNTY OF BOUNDARY

MAGISTRATE DIVISION

In the Interest of: ) Case No. CV-2011-

)
) GUARDIAN AND CONSERVATOR OF
An Incapacitated Person. _________) INCAPACITATED PERSON

COMES NOW, Petitioner XXXXXXXX through his attorney, ______________, and

states and represents to the Court as follows:

1. Petitioner, XXXXXXXX, is the son of XXXXXXXXXXX, and he is interested in the estate,

affairs or welfare of XXXXXXXXXXX, who is an incapacitated person.

2. The incapacitated person is eighty-one (81) years of age and was born on April 5, 1929. He

presently resides at Valley Vista Care Center of Sandpoint, a nursing home facility located at 220 S

Division Ave., Sandpoint, ID 83864.

3. XXXXXXXXXXX is an incapacitated person as defined in Idaho Code § 15-5-101(a) in that

he suffers from dementia, heart disease, blackouts, glaucoma and chronic back pain and, as a

result, he lacks sufficient understanding or capacity to make responsible decisions regarding his

person, property, and affairs.

4. Appointment of an emergency guardian is necessary to prevent substantial harm to Mr.

XXXXX’s health, safety and welfare before a hearing can be held.

5. Following appointment of an emergency guardianship, appointment of a general

guardianship is necessary and desirable as a means of providing continuing care and supervision

for Mr. XXXXXXXXXXX.

PETITION - 1.
6. No guardian has been appointed by this incapacitated person by will or by order of any

Court.

7. Gaila, _______________, Vancouver, WA    98665, Stephen, ___________, Vinegrove,

KY   40175-9688, _____________, Colorado Springs, CO    80911, Wanda ____________,

Langley, WA    98260, Annette ________________, ID    83805, are the nearest known

relatives of the XXXXXXXXXXX and are his children. His wife is deceased.

8. Venue is proper in this proceeding in Bonner County, Idaho because the incapacitated

person resides there.

9. The appointment of the Petitioner is in the best interest and welfare of the incapacitated

person because he is medically incapable of caring for himself and as a result of the combined

ailments is not competent to make valid decisions concerning his medical care, financial matters,

management of his estate and property, or to provide for his personal housing, maintenance and

support.

10. Petitioner is a competent person who resides in El Paso County, Colorado, and suitable to

serve as guardian for the incapacitated person as he has been acting as the said person’s agent

under a General Power Of Attorney, dated September 2, 2010. (Attached as Exhibit A). Such

appointment is necessary as a means of providing continuing care and supervision of the

incapacitated person.

11. The incapacitated person is presently in the care of Valley View Care Center of Sandpoint

and there is no guardian or conservator appointed for him in this jurisdiction or any other

jurisdiction.

PETITION - 2.
12. Petitioner has priority for appointment as guardian, as he is currently acting as

XXXXXXXXXXX’s attorney in fact and agent under a Power of Attorney with the approval and

consent of the aforementioned relatives.

13. The guardianship type is a general guardianship that should be granted because nothing less

than a general guardianship will be adequate.

14. Said protected person is unable to manage his own property and affairs effectively because

of the above-described and set forth combined conditions.

a. Appointment of a Conservator is necessary because said person to be protected has

property which will be wasted or dissipated unless property management is provided,

and said person has income, funds and resources to be used for his support, care and

welfare.

b. Protection is necessary or desirable to obtain, safeguard and provide such funds.

15. The proposed guardian/conservator ________________ has a mailing address of

_____________, Colorado Springs, CO    80911.

16. Notice of the time and place of hearing on this Petition is required to be given to the

following persons:

Gaila _____ ___________________ Stepdaughter

Vancouver, WA    98665

Stephen _______ __________________ Stepson

Vinegrove, KY   40175-9688

Wanda ____ _______________ Daughter

Langley, WA    98260

Annette ______ _________ Daughter

_______, ID  83805

PETITION - 3.
17. The request for emergency temporary and permanent guardian and conservator is

evidenced by the referral letter of Dr. _____________ dated February 18, 2011, a copy of which

is attached as Exhibit B.

WHEREFORE, Petitioner prays for this Court to:

A. Set this petition for appointment of temporary guardian and conservator for

immediate hearing;

B. Appoint Richard White as XXXXXXXXXXX’s temporary Guardian and Conservator

until a full hearing may be held, but not to exceed ninety (90) days;

C. Appoint _________ as Court Visitor to interview XXXXXXXXXXX and the

proposed guardian and prepare a report to the Court, pursuant to Idaho Code § 15-5-308;

D. Appoint ______ as counsel to represent XXXXXXXXXXX;

E. Appoint the proposed ward’s treating physician, ______, as physician to examine

Mr. _____;

F. Set this Petition for permanent appointment of general guardian and conservator

within ninety (90) days.

DATED this _____ day of ____________________________, 2011.

______________________________
XXXXXXXX
Petitioner

PETITION - 4.
 VERIFICATION

STATE OF )
) ss.
County of )

The undersigned, XXXXXXXX, being sworn says that the facts set forth in the foregoing

Petition are true, accurate and complete to the best of his knowledge, information and belief.

DATED this ______ day of ________________________, 2011.

_______________________________
XXXXXXXX

SUBSCRIBED and SWORN to before me this _____ day of ____________, 2011.

_______________________________
NOTARY PUBLIC – State of Idaho
Commission Expires: ________________

PETITION - 5.
 CERTIFICATE OF MAILING

I hereby certify that on the _____ day of _________________, 2011, I caused to be

served a true and correct copy of the foregoing document as addressed to the following:

XXXXXXXX XXXXXXX
Attorney for XXXXXXXXXXX ______Street
P.O. Box ____ Sandpoint, ID 83864
Coeur d’Alene, ID 83816

XXXXXX XXXXXX
Attorney at Law ________.
____________ Colorado Springs, CO 80911
Sandpoint, ID 83864

XXXXXXXXXXX Gaila
c/o Valley Vista Care Center of Sandpoint ____________
220 S Division Ave., Sandpoint, ID 83864 Vancouver, WA  98665

Stephen Wanda
_______________ ____________
Vinegrove, KY   40175-9688 Langley, WA    98260

Annette
P.O. Box ____
_______, ID    83805

_____________________________
Legal Assistant

PETITION - 6.