GUARDIANSHIP INTAKE INFORMATION

Instructions:

1. Please read this entire form before you begin filling it out as it can't be saved. Thus, when you have answered all the questions and you hit submit, you can't get back to the form. If you want to keep a copy for your records which is not required take a screen shot for yourself.

2. We realize this questionnaire is complicated. However, we have tried to make it as simple as possible. Please call if you do not understand anything!! DO NOT FILL OUT INCORRECTLY, CALL US INSTEAD!

3. Do not leave blanks, if answer is no or none, write no or none, or we will think you forgot to read the question.

4. The guardian is the person who will supervise the IP (incapacitated person-or minor).

5. We may need some of the following before submission. Thus, you should begin obtaining this documentation now so that it is ready when we need it: Medical records (if applicable) showing in detail why the IP needs a guardian.

Spell out how much five and five equals.

GUARDIAN INFORMATION

First Name

Middle Name

Last Name

Address

City

State

Zip

Email address

Phone

2nd phone

Relationship to IP

Why are you suitable for this position

CO-GUARDIAN INFORMATION

First Name

Middle Name

Last Name

Address

City

State

Zip

Email address

Phone

2nd phone

Relationship to IP

Why are you suitable for this position

IP (INCAPACITATED PERSON) INFORMATION

First Name

Middle Name

Last Name

Address

City

State

Zip

Email address

Phone

2nd phone

Date of Birth

For EVERY person who resides with IP provide following

Person 1

First Name

Middle Name

Last Name

Relationship

Phone

2nd phone

Person 2

First Name

Middle Name

Last Name

Relationship

Phone

2nd phone

Person 3

First Name

Middle Name

Last Name

Relationship

Phone

2nd phone

Person 4

First Name

Middle Name

Last Name

Relationship

Phone

2nd phone

Person 5

First Name

Middle Name

Last Name

Relationship

Phone

2nd phone

Person 6

First Name

Middle Name

Last Name

Relationship

Phone

2nd phone

If more than 6 people live with the IP, neatly write their information down and mail it to us at Greenberg & Merola, 2280 Grand Ave., Ste. 202, Baldwin, NY 11510.

For every parent, child, & sibling of the IP provide following REGARDLESS OF WHERE THEY LIVE

Person 1

First Name

Middle name

Last name

Relationship

Phone

2nd phone

Address

City

State

Zip

Person 2

First Name

Middle name

Last name

Relationship

Phone

2nd phone

Address

City

State

Zip

Person 3

First Name

Middle name

Last name

Relationship

Phone

2nd phone

Address

City

State

Zip

Person 4

First Name

Middle name

Last name

Relationship

Phone

2nd phone

Address

City

State

Zip

Person 5

First Name

Middle name

Last name

Relationship

Phone

2nd phone

Address

City

State

Zip

Person 6

First Name

Middle name

Last name

Relationship

Phone

2nd phone

Address

City

State

Zip

Person 7

First Name

Middle name

Last name

Relationship

Phone

2nd phone

Address

City

State

Zip

Person 8

First Name

Middle name

Last name

Relationship

Phone

2nd phone

Address

City

State

Zip

If there are more than 8 people, neatly write their information down and mail it to us at Greenberg & Merola, 2280 Grand Ave., Ste. 202, Baldwin, NY 11510

Describe the functional level of the IP, including their ability to manage the activities of daily living, behavior and understanding and appreciation of the nature and consequences of any inability to manage these activities of daily living (THIS SIMPLY MEANS DESCRIBE WHY THE IP NEEDS A GUARDIAN)

The approximate value and description of the financial resources of the IP are as follows (include value of assets, value of debt, monthly income, source, where income goes, who is taking care of this now & how.

Is IP receiving public assistance and if so, details.

List IP's outstanding claims, debts, and/or obligations if any

Has anyone ever applied to any court before to be a guardian of the IP and if so, full details here and mail written documentation to us at Greenberg & Merola, 2280 Grand Ave., Ste. 202, Baldwin, NY 11510.

Submit

WE ARE LAWYERS FOR LEGAL PLANS
Call today to see if your plan is one of them

CONTACT US AT:
GREENBERG & MEROLA, Attorneys at Law
521 5th Avenue, Suite 1700, New York, NY
2280 Grand Avenue, Suite 2280, Baldwin, NY
Conference Offices: Nassau, Brooklyn, Queens, Westchester, Bronx, Suffolk

521 5th Ave., Ste. 1700, New York NY	2280 Grand Ave., Ste. 202, Baldwin NY	26 Court St., Bklyn NY	1129 Northern Blvd., Manhasset NY	214-11 Northern Blvd., Bayside NY	145-11 Jamaica Ave., Jamaica NY	547 N. Ave., New Rochelle NY	749 E. 135th St., Bronx NY	150 Motor Pkwy., Hauppauge NY

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