Filing 37523784 E?Filed 02/08/2016 12:16:04 PM

IN THE CIRCUIT COURT OF THE FIFTEENTH
JUDICIAL CIRCUIT IN AND FOR PALM
BEACH COUNTY, FLORIDA

IN RE: GUARDIANSHIP OF

MARI M. MONTGOMERI,

PROBATE DIVISION IH

FILE 

 

 

an alleged incapacitated
person.

APPLICATION FOR APPOINTMENT AS GUARDIAN

Pursuant to Section 744.3125 of the Florida Guardianship Law, the
undersigned submits this Application for Appointment as Guardian of 
M. (the Ward) and submits the following information (whenever

the space provided is insufficient, attach additional pages):

Name: HILDA SANTANA
Age: ESES
Residence address: 2242 Gabriel Lane

West Palm Beach, FL 33406
Mailing address: Same

U.S. citizen? Yes No
Employer's name and address:



Applicant's position:

Home telephone number: 3 
Work telephone number: 

If currently serving as guardian for any other ward, list

names of each ward, court file number(s), circuit courtts) in which the

case(s) is/are pending and whether applicant is acting as the limited or

plenary guardian of the person or property or both:



FILED: PALM BEACH COUNTY, SHARON R. BOCK, CLERK, 02/08/2016 12:16:04 PM

 Does applicant have any physical disabilities? Yes
No If yes, please describe and state whether such disability

may affect applicant's ability, in any degree, to serve as guardian:

 

 

 

10. Has applicant ever been treated for the follojigg},x

 

 

 

a. Mental condition? Yes No 4;
b. Alcohol? Yes Nb P?f,
c. Drugs? Yes No 
d. Other? Yes No h?ff

 

Nature of condition and summary of treatment:

 

 

 

11. Has applicant ever been judicially determined to have
committed abuse, abandonment or neglect against a child as defined by
the Florida Statutes? Yes No

12. Has applicant ever been the subject of a confirmed report of
abuse, neglect, or exploitation which has been uncontested or upheld
pursuant to the provisions of Sectio 415.104 and 415.1075, Florida
Statutes? Yes No 

13. Has applicant ever been charged with fraud, misrepresentation
or perjury 'n a judicial or administrative proceeding? Yes
No If yes, please give date and complete details:



 

 

 

14. Has applicant ever been chargedt/3ith? arrested for or
convicted of a felony? Yes No If yes, please
furnish details including date, type of offense, location and final

disposition:

 

 

 

 

15. Has applicant ever been charged for or
convicted of any other crimes? Yes No If yes,
please furnish details including date, type of offense, location and

final disposition:

 

 

 

 

16. Has applicanj/pver held a position which required bonding?
Yes No If yes, please describe position, date,

 

amount of bond and name of surety:

 

 

 

 

17. Has applicant ever served as guardian of a person or of a

person's property? Yes NO If yes, please

 

describe below, including reason for termination of fiduciary position:_

 

 

18. Has applicant ever been hfig/in contempt of court or removed
as guardian? Yes No If yes, please describe

below:

 

 

 

19 Has applicant ever filed for bankruptcy? Yes
No 

If yes, please state date and location of court:

 

 

 

20. What is applicant's relationship to the alleged incapacitated
person? \ma J?applicant, or applicant's corporation or other business

 

entity a creditor of, or providing professional, 
services to the incapacitated person? Yes No If yes,

please furnish details:

 

 

 

 

 

 

22. Is applicant employed by a corporation or other entity which
is providing' professional, personal on?;9ysiness services to the

incapacitated person? Yes No If yes, please furnish

 

details:

 

 

 

 

 

 

23. Is applicant a health care ovider for the alleged
incapacitated person? Yes No 
24. Educational history of applicant:
Name and address

DBQIBE Date

High school: 0&1 Nemmnm \r-b?dn ilnad 

 

College:??hlm  Mmun??j   

 

Other:

 

 

25. List applicant's employment experience for the past ten (10)

years beginning with the most recent date:

 

Name and address Date Reason for leaving

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26. Was applicant discharged from employment by any employer
listed above?
Yes No If yes, please explain: ?215,15

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27. Does applicant possess any pecial educational qualifications
(financial, business or otherwise) that qualifies applicant to be
appointed as guardian? Yes No If es, please

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