Application for Guardianship
About You
You will be the Applicant—so if you see that term, it means you!
Name
*
First Name
Middle or Initial
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Can I text you at this number?
*
Yes
No
Last three digits of your social security number or tax ID number
*
This is required by the Texas Rules of Civil Procedure
Last three digits of your driver's license
This is required by the Texas Rules of Civil Procedure
Which state issued your driver's license?
Have you ever been convicted of a felony or any crime involving theft or trust (such as fraud)?
No
Yes
Do you owe any money to the Proposed Ward, or have any other interest that could be considered adverse?
No
Yes
If you answered Yes above, please describe the debt or adverse interest.
If you have a medical or financial power of attorney, upload it here or email it to me: Robert@JewettLaw.net
Browse Files
If you don't have an electronic copy, you can fax it to me at 281-581-9114.
Cancel
of
Physicians Certificate of Medical Examination
If you have an electronic copy of the PCME, upload it here. If you do not yet have a PCME, you should schedule with the Proposed Ward's physician as soon as possible. If you or the physician does not have a PCME form, you can obtain one at https://probatecrt4.harriscountytx.gov/Documents/Revised%20October%202016%20Guardianship%20Referral%20and%20Physician's%20Certificate%20of%20Medical%20Examination.pdf
Browse Files
If you don't have an electronic copy, you can fax it to me at 281-581-9114.
Cancel
of
Information about the Proposed Ward
The following questions all pertain to the Proposed Ward (the person you are seeking Guardianship for)
Proposed Ward's Name
First Name
Middle Name
Last Name
Home / Residence Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Where the Ward is staying (if not at home)
Current Address (if in a care facility or not at home)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Social Security Number
Driver's License
Has the Proposed Ward ever executed a Declaration of Guardian?
Yes
No
If yes, who is named as the selected guardian?
Has the Proposed Ward ever executed a Financial Power of Attorney
Yes
No
If yes, who is named as the agent?
Has the Proposed Ward ever executed a Medical Power of Attorney
Yes
No
If yes, who is named as the agent?
Does the Proposed Ward own a home?
Yes
No
If yes, what is the address?
Does the Proposed Ward own a vehicle?
Yes
No
If yes, describe make, model, and year.
What is your best guess as to the value of the Proposed Ward's bank accounts and investments? Please provide a dollar amount. Be as accurate as you can without going to extremes. You will submit an inventory with more precise amounts within 45 days of appointment.
Does the Proposed Ward receive social security?
Yes
No
List all children of the Decedent, whether living or deceased. For each child, list their name, address, date of birth, phone number, and email address. If you do not know one of these items, list it as "unknown." If the child is deceased, list only their name and any children the deceased child may have had.
List the parents of the Decedent, whether living or deceased. For each parent, list their name, address, date of birth, phone number, and email address. If the parent is deceased, list only their name and date of death. If you do not know one of these items, list it as "unknown."
List the siblings of the Decedent, whether living or deceased. For each sibling, list their name, address, date of birth, phone number, and email address. If the sibling is deceased, list only their name and date of death. If you do not know one of these items, list it as "unknown."
If you are requesting a Temporary Guardianship, describe the imminent danger to the Proposed Ward.
Lists any other facts and reasons supporting the allegations and requests in the application.
Submit
Should be Empty: