Md. R. Guard. & Fid. 10-112

As amended through November 13, 2024

Rule 10-112 - Petition for Guardianship of Alleged Disabled Person

A petition for guardianship of an alleged disabled person shall be substantially in the following form:

[CAPTION]

In the Matter of	In the __________ Court for
__________________________	____________________________
(Name of minor)	(County)
____________________________
(docket reference)

PETITION FOR GUARDIANSHIP OF

ALLEGED DISABLED PERSON

INSTRUCTIONS

(1) Use this form of petition when a guardianship of an alleged disabled person, as defined in Code, Estates & Trusts Article, § 13-101(f) and Rule 10-103(b) is sought.

(2) If the subject of the petition is a minor including a disabled minor, use the form petition set forth in Rule 10-111.

(3) If guardianship of more than one alleged disabled person is sought, a separate petition must be filed for each alleged disabled person.

(4) If the petition is to be filed in the Circuit Court for Baltimore City, use "Baltimore City" as the name of the county.

[ ]	Guardianship of	[ ]	Guardianship of	[ ]	Guardianship of
Person	Property	Person and
Property

The petitioner, _________(name)________, ___(age)__, whose address is __________________________________________, and whose telephone number is __________________________, represents to the court that:

1. The alleged disabled person ___________________________, age ______, born on the ________ day of ___________, __________, (month) (year) a [ ] male or [ ] female resides at ____________________________ _______________________________________________________________.

2. If the alleged disabled person does not reside in the county in which this petition is filed, state the place in this county where the alleged disabled person is currently located ________________________________________________________________ ________________________________.

NOTE: For purposes of this Form, "county" includes Baltimore City.

3. The relationship of petitioner to the alleged disabled person is _____________________________________________________.

4. The alleged disabled person

[ ] is a beneficiary of the Department of Veterans Affairs and the guardian may expect to receive benefits from that Department.

[ ] is not a beneficiary of the Department of Veterans Affairs.

5.Complete Section 5 if the petitioner is asking the court to appoint the petitioner as the guardian.

(Check only one of the following boxes)

[ ] I have not been convicted of a crime listed in Code, Estates and Trusts Article, § 11-114.

[ ] I was convicted of such a crime, namely _____________ ______________________________________________________________. The conviction occurred in ____(year)____ in the ______________(name of court)_______________, but the following good cause exists for me to be appointed as guardian: _____________________ _______________________________________________________________.

6.Complete Section 6. if the petitioner is asking the court to appoint an individual other than the petitioner as the guardian.

6a. Prospective Guardian of the Person (Complete Section 6 a. if seeking guardianship of the person.)

The name of the prospective guardian of the person is _______________________________________________________ and that individual's age is __________. The relationship of that individual to the alleged disabled person is _________________ _______________________________.

(Check only one of the following boxes)

[ ] _________________________________ has not been convicted (Name of prospective guardian) of a crime listed in Code, Estates and Trusts Article, § 11-114.

[ ] ________________________________________ was convicted of such a crime, namely ___________________________________________ ________________________________. The conviction occurred in ____(year)____ in the ______________(name of court)_______________, but the following good cause exists for me to be appointed as guardian: _____________________ _______________________________________________________________.

6b. Prospective Guardian of the Property (Complete Section 6 b. if the prospective guardian of the property is different from the prospective guardian of the person or if guardianship of the person is not sought.) The name of the prospective guardian of the property is ______________________________________________ and that individual's age is __________. The relationship of that individual to the alleged disabled person is _________________ _______________________________.

(Check only one of the following boxes)

[ ] _________________________________ has not been convicted (Name of prospective guardian) of a crime listed in Code, Estates and Trusts Article, § 11-114.

[ ] ________________________________________ was convicted of such a crime, namely ___________________________________________ ________________________________. The conviction occurred in ____(year)____ in the ______________(name of court)_______________, but the following good caus exists for the individual to be appointed as guardian: ___________________________________________________ _______________________________________________________________.

7. If the alleged disabled person resides with petitioner, then state the name and address of any additional person on whom initial service shall be made: __________________________________________________________________________________________.

8. The following is a list of the names, addresses, telephone numbers, and e-mail addresses, if known of all interested persons (see Code, Estates and Trusts Article, § 13-101(k)):

Name	Address	Telephone	E-mail Address
		Number	(if known)
Person or Health Care Agent Designated
in Writing by Alleged Disabled Person:	___________	___________	___________	___________

Spouse or Registered Domestic Partner:	___________	___________	___________	___________

Parents:	___________	___________	___________	___________
___________	___________	___________	___________

Adult Children:	___________	___________	___________	___________
___________	___________	___________	___________
___________	___________	___________	___________
___________	___________	___________	___________

Adult Grandchildren*:	___________	___________	___________	___________
___________	___________	___________	___________

Siblings*:	___________	___________	___________	___________
___________	___________	___________	___________
___________	___________	___________	___________
___________	___________	___________	___________

Any Other Heirs at Law:	___________	___________	___________	___________

Guardian (if appointed):	___________	___________	___________	___________

Any Person Holding a Power
of Attorney of the Alleged Disabled Person:	___________	___________	___________	___________

Alleged Disabled Person's Attorney:	___________	___________	___________	___________

A Supporter Pursuant to a Supported
Decision-Making Agreement:	___________	___________	___________	___________

Any Other Person Who Has Assumed
Responsibility for the Alleged Disabled Person:	___________	___________	___________	___________

Any Government Agency Paying Benefits
to or for the Alleged Disabled Person:	___________	___________	___________	___________

Any Person Having an Interest
in the Property of the Alleged Disabled Person:	___________	___________	___________	___________

All Other Persons Exercising Control over the Alleged
Disabled Person or the Alleged Disabled Person's Property:	___________	___________	___________	___________

A Person or Agency Eligible to Serve as Guardian of the Person of the Alleged Disabled Person (Choose A or B below):

A. Director of the Local Area Agency on Aging
(if Alleged Disabled Person is Age 65 or over):	___________	___________	___________	___________
B. Local Department of Social Services
(if Alleged Disabled Person is Under Age 65):	___________	___________	___________	___________

* Note: Adult grandchildren and siblings need not be listed unless there is no spouse or registered domestic partner and there are no parents or adult children.

9. The names and addresses of the persons with whom the alleged disabled person resides or has resided over the past five years and the approximate dates of the alleged disabled person's residence with each person are as follows:

Names	Addresses	Approximate Dates
_________________________	_________________________	_________________________
_________________________	_________________________	_________________________
_________________________	_________________________	_________________________
_________________________	_________________________	_________________________

10. A brief description of the alleged disability and how it affects the alleged disabled person's ability to function is as follows: _______________________________________________________________.

11.

(a) Guardianship of the Person is sought because __________________ (Name of Alleged Disabled Person)_________________ cannot make or communicate responsible decisions concerning health care, food, clothing, or shelter, because of mental disability, disease, habitual drunkenness, addiction to drugs, or other addictions. State the relevant facts:

_______________________________________________________________.

(b) Describe less restrictive alternatives that have been attempted and have failed (see Code, Estates and Trusts Article, § 13-705(b)):

_______________________________________________________________.

12.

(a) Guardianship of the Property is sought because ________________________________________ cannot manage property (Name of Alleged Disabled Person) and affairs effectively because of physical or mental disability, disease, habitual drunkenness, addiction to drugs or other addictions, imprisonment, compulsory hospitalization, detention by a foreign power, or disappearance. State the relevant facts:

_______________________________________________________________.

(b) Describe less restrictive alternatives that have been attempted and have failed (see Code, Estates and Trusts Article, § 13-201):

_______________________________________________________________.

13. If this Petition is for Guardianship of the Property, the following is the list of all the property in which the alleged disabled person has any interest including an absolute interest, a joint interest, or an interest less than absolute (e.g. trust, life estate):

			Sole Owner, Joint
			Owner (specific type),
			Life Tenant, Trustee,
Property	Location	Value	Custodian, Agent, etc.
_________________________	_________________________	_________________________	_________________________
_________________________	_________________________	_________________________	_________________________

14. The petitioner's interest in the property of the alleged disabled person listed in 13. is __________________ _______________________________________________________________.

15. If a guardian or conservator has been appointed for the alleged disabled person in another proceeding, the name and address of the guardian or conservator and the court that appointed the guardian or conservator are as follows:

______________________________	______________________________
Name	Address
______________________________
Court

______________________________ ____________________________ ______________________________

16. All other proceedings regarding the alleged disabled person (including criminal) are as follows: _______________________________________________________________.

17. All exhibits required by the Instructions below are attached.

WHEREFORE, Petitioner requests that this court issue an order to direct all interested persons to show cause why a guardian of the [ ] person [ ] property [ ] person and property of the minor should not be appointed, and (if applicable) _(Name of prospective guardian)_ should not be appointed as the guardian.

______________________________
Attorney's Signature
______________________________	___ If There is No Attorney: ___
Attorney's Name
______________________________	______________________________
Attorney's Address	Petitioner's Address
______________________________	______________________________
Attorney's Telephone Number	Petitioner's Telephone Number
______________________________	______________________________
Attorney's E-mail Address	Petitioner's E-mail Address

Petitioner solemnly affirms under the penalties of perjury that the contents of this document are true to the best of Petitioner's knowledge, information, and belief.

_____________________________

Petitioner's Name

_____________________________

Petitioner's Signature

ADDITIONAL INSTRUCTIONS

1. The required exhibits are as follows:

(a) A copy of any instrument nominating a guardian;

(b) A copy of any power of attorney (including a durable power of attorney for health care) which the alleged disabled person has given to someone;

(c) A copy of any written supported decision-making agreement (see Code, Estates and Trusts Article, § 18-107);

(d) Signed and verified certificates of two health care professionals who have examined or evaluated the alleged disabled person. The health care professionals shall be either two physicians licensed to practice medicine in the United States or one such licensed physician and one licensed psychologist licensed certified social worker-clinical, or nurse practitioner. An examination or evaluation by at least one of the health care professionals must have occurred within 21 days before the filing of the petition (see Code, Estates and Trusts Article, § 13-103 and § 1-102(a) and (b)).

2. Attach additional sheets to answer all the information requested in this petition, if necessary.

Md. R. Guard. & Fid. 10-112

This Rule is new.

Adopted Sept. 17, 2015, eff. 1/1/2016. Amended Oct. 10. 2017, eff. 1/1/2018; Nov. 19, 2019, eff. 1/1/2020; amended March 30, 2021, eff. 7/1/2021; amended April 21, 2023, eff. 7/1/2023; amended April 5, 2024, eff. 7/1/2024.

HISTORICAL NOTES

2017 Orders

The October 10, 2017, order changed the word "jurisdiction to the word "county" in Section 2 and added a "NOTE" pertaining to the use of the word "county," added language and boxes to check pertaining to an alleged disabled person who may be a beneficiary of the Veterans Administration, divided Section 6 into two subsections, added language to Section 6 pertaining to a request for certain information about a conviction of a crime, changed the word "an" to the word "any" in Section 7, added, in Section 8, the words "and e-mail addresses, if known," updated a cross reference, changed the term "Local Commission on Aging and Retirement Education" to "Director of the Local Area Agency on Aging," deleted the word "confinement" from Section 12, deleted the requirement at the end of the form that a facsimile number be provided, and made stylistic changes.