Case Information Sheet For
Guardianships and Conservatorships 	Case Number (Clerk fills in case #):
	
	Exempt from Public Disclosure	
 
  Disclosure of this information is limited by Idaho Court Administrative Rule 32.

1.	Type of case:	 Guardianship    Conservatorship    Both
				
2.	Contact information for Person asking to become Guardian and/or Conservator
	
	A. Proposed Guardian and/or Conservator

	Full Legal Name: 																                				First 	                            Middle 	                               Last 

	Any other names used:														

	Physical Address: 														
						Street 					City 			State 		Zip 

	Work Address: 															
						Street 					City 			State 		Zip 

	Phone numbers:															 	 						Home 			Work 				  	 Cell 	 

	Social Security Number	:				 Date of Birth:			Sex:  Male   Female

	Driver’s License State & Number: 												 

	Email Address: 															

B. Second Proposed Guardian and/or Conservator, if any (if there is more than one person asking to become a guardian or conservator, provide that person’s contact information below)
	
	Full Legal Name: 																                				First 	                            Middle 	                               Last 

	Any other names used:														

	Physical Address: 														
						Street 					City 			State 		Zip 

	Work Address: 															
						Street 					City 			State 		Zip 

	Phone numbers:															 	 						Home 			Work 				  	 Cell 	 

	Social Security Number	:				 Date of Birth:			Sex:  Male   Female

	Driver’s License State & Number: 												

	Email Address: 															

3.	For the person who may need a guardian or conservator, list all other people living in the household (add additional pages if needed)
Name:											Age:					
Name:											Age:					
Name:											Age:					
Name:											Age:					

4.	Information about the person who may need a guardian and/or conservator:

	Full Legal Name: 																                					First 	                            Middle 	                               Last 

	Any other names used:														

	Physical Address: 														
						Street 					City 			State 		Zip 

	If address is a facility, name and contact number for the facility: 						

	Work Address: 															
						Street 					City 			State 		Zip 

	Phone numbers:															 	 						Home 			Work 				  	 Cell 	 

	Social Security Number	:				 Date of Birth:			Sex:  Male   Female

	Driver’s License State & Number: 			 Email Address: 								
	Height: 		  Weight: 			    Eye Color: 	  		    Hair Color: 			
	
	Are there any plans to move the person into a different home?      Yes    No   
If yes, provide the information for the new home below:
	
	Physical Address: 														
						Street 					City 			State 		Zip 
	Phone number:															

	If address is a facility, name and contact number for the facility: 						

5.  Other cases involving the person who may need a guardian or conservator named on this form (list any guardianship, conservatorship, or other cases filed in another state or county)

Case Number	Date of Order 
(or date requested)	County / State	Type of case	
1.			 Guardianship            Conservatorship
 Both                          Other _________________	
2.			 Guardianship            Conservatorship
 Both                          Other _________________	
3.			 Guardianship            Conservatorship
 Both                          Other _________________