Confidential intake

Guardianship & Conservatorship Intake Form

Thank you for choosing Messick Law. The information you provide in this form is necessary to initiate a guardianship and/or conservatorship for the Respondent.

If you are seeking appointment as a Guardian and/or Conservator, you will be asked to watch a short court training video — you'll find it in the Training & Resources section near the end of this form. You will need to attest to watching it in your petition.

Your progress is saved automatically to this device. Nothing is transmitted to our office until you choose to send it.

What you're asking the court for

Minnesota has two related but separate court protections. Many people need one; some need both. You do not need to know the answer now — if you're unsure, choose “Not sure / help me decide” and your attorney will work through it with you.

Guardianship Decisions about the person — residence, medical care, personal needs Conservatorship Decisions about money & property — income, bills, assets Both Decisions about both the person and their money & property Not sure / help me decide Leave this open — we'll determine the right relief together

Anything you'd like us to know about why you're seeking this? (optional)

Approx. 20–30 minutes

Section 1

Your information

Please use your full legal name as it appears on your government-issued ID. Fields marked with * are required so our office can reach you.

Identification & contact

Your full legal name

Your street or post office box address

City

State

ZIP

Your phone number

Your email address

Relationship to the Respondent

Your relationship with the Respondent (the person who will be subject to the guardianship or conservatorship)

Section 2

The Respondent

The Respondent is the person who will be subject to the guardianship or conservatorship.

Identification & contact

Respondent's full legal name

Respondent's street address (where the Respondent lives)

City

State

ZIP

Respondent's telephone number

Respondent's age

Respondent's date of birth

Residence

If the petition is granted, will there be a change in the Respondent's residence?

Yes No

Incapacitation

This information supports the petition's statement of why a guardianship or conservatorship is needed. Plain language is fine — we will review this with you.

Respondent's diagnosis(es)

Why does the Respondent need a guardianship or conservatorship?

What less restrictive alternatives have been attempted or considered, and why are they not sufficient?

Section 3

Interested persons — spouse & household

Minnesota law requires notice to certain "interested persons." This section and the next help us identify them.

Spouse

Is the Respondent married?

Yes No

Other adults in the household

Apart from the Respondent's spouse (if married), has the Respondent resided with an adult for more than six (6) months before filing this Petition?

Yes No

Section 4

Interested persons — children & family

Children & stepchildren

Does the Respondent have children or stepchildren?

You only need to list stepchildren who are the children of a living spouse of the Respondent.

Yes No

Other interested persons

Is there anyone else with an interest in this matter?

For example: a legal representative (an existing guardian or conservator, representative payee, trustee, or custodian of property); a person nominated as guardian in a prior court order or health care directive; or other immediate family you want the court to know about.

Yes No

Section 5

Institutions & existing documents

Facility or agency

Is the Respondent a resident of, or currently admitted to, a hospital, nursing home, VA unit, group home, home care agency, or other institution?

Yes No

Health Care Directive

Does the Respondent have a Health Care Directive?

Yes No

Power of Attorney

Has the Respondent executed a Power of Attorney form?

Yes No

Section 6

Information about the Respondent — status & benefits

Status

Is the Respondent a patient at a State Hospital for persons with mental illnesses?

Yes No

Is the Respondent committed to the Commissioner of the Minnesota Department of Human Services?

Yes No

Does the Respondent appear to understand the nature and effect of voting in elections?

Yes No

Public assistance

Is the Respondent receiving public assistance under one or more of the following means-tested programs? Please select all that apply.

MSA Minnesota Supplemental Assistance MFIP Minnesota Family Investment Program Food Stamps General Assistance or Discretionary Work Program MinnesotaCare, Medical Assistance, or General Assistance Medical Assistance Energy Assistance Other please specify below

SSDI / SSI

Does the Respondent receive income from Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) programs?

Yes No

Section 7

Information about the Respondent — income & support

Income

Respondent's gross monthly income (before taxes and other deductions)

If the Respondent is receiving monthly income, select the source(s) of said income:

Job / wages Unemployment benefits Spousal support Trust income Social Security Other please specify below

Spouse's income

If the Respondent is married, does the Respondent's spouse receive monthly income?

Yes No Unknown

Child support & spousal maintenance

Does the Respondent receive any child support payments (including medical support and childcare support)?

Yes No

Is the Respondent obligated to pay child support (including medical support and childcare support)?

Yes No

Is the Respondent subject to a court order to make spousal maintenance payments?

Yes No

Section 8

Respondent's assets & debts

Approximate values are fine. Please state the approximate value of the following assets that the Respondent owns.

Assets

Asset	Approximate value
Cash on hand
Total funds in bank accounts (checking and savings)
Value of vehicles (Bluebook value less the principal balance of any loans)
Value of real estate (tax value less the principal balance of any mortgage/loan)
Estimated total	$0

Other assets of value

Debts

Total amount of any debts owed by the Respondent Not including those debts already accounted for above (vehicle loans, mortgages).

Section 9

Proposed Guardian(s)/Conservator(s)

Please state the following information for all persons who you want to serve as Guardian(s) and/or Conservator(s) of the Respondent. The same person may serve in both roles.

Proposed Guardian(s)/Conservator(s)

Guardianship powers — decisions about the person

Complete this section if you are seeking a guardianship. The petition must state which powers the Guardian needs to protect and supervise the Respondent (Minn. Stat. § 524.5-313(c)).

All powers Full guardianship — all of the rights and powers under Minn. Stat. § 524.5-313(c), paragraphs 1–7, 9, and 10 Limited powers Limited guardianship — only the specific powers selected below

Conservatorship powers — decisions about money & property

Complete this section if you are seeking a conservatorship. The petition must state which powers the Conservator needs to provide for the Respondent's financial needs (Minn. Stat. § 524.5-417).

All powers Full conservatorship — all of the powers and duties under Minn. Stat. § 524.5-417 Limited powers Limited conservatorship — only the specific powers selected below

Background disclosures

The court requires the following disclosures about every proposed Guardian/Conservator. If any answer is "Yes," a follow-up field will appear.

Do any of the proposed Guardian(s)/Conservator(s) anticipate charging a fee for the performance of their services?

Yes No

Have any of the proposed Guardian(s)/Conservator(s) been removed for cause from serving as a Guardian or Conservator?

Yes No

Are any of the proposed Guardian(s)/Conservator(s) professional guardians or conservators (engaged in the business of providing guardianship or conservatorship services for others)?

Yes No

Have any of the proposed Guardian(s)/Conservator(s) applied for or held a professional license?

Yes No

Have any of the proposed Guardian(s)/Conservator(s) been found civilly liable in an action involving fraud, misrepresentation, material omission, misappropriation, theft, or conversion?

Yes No

Have any of the proposed Guardian(s)/Conservator(s) filed for or received protection under bankruptcy laws in the last five (5) years?

Yes No

Do any of the proposed Guardian(s)/Conservator(s) have an outstanding civil monetary judgment?

Yes No

Have any of the proposed Guardian(s)/Conservator(s) had an order for protection or harassment restraining order issued against them?

Yes No

Have any of the proposed Guardian(s)/Conservator(s) been convicted of a gross misdemeanor or felony?

Yes No

Section 10

Supporting documents

Documents are uploaded separately through the firm upload site provided in your new client welcome form — not through this intake.

Documents

Does the Respondent have an Individualized Education Plan (IEP)?

Yes No

Are the Respondent's physicians in support of a guardianship or conservatorship for the Respondent?

Yes No

Does any other organization, entity, or government agency recommend that the Respondent have a Guardian and/or Conservator?

Yes No

Section 11

Training & resources

Before you submit, please review the court's training video and the resources below.

Required training video

Open the training video ↗

If the button does not open, copy this address into your browser: guardianvideo-mmg.courts.state.mn.us

Have you watched the training video? You may submit either way, but you must watch the video before your petition can be filed.

Helpful resources

Additional information can be found in the Minnesota Guardianship and Conservatorship handbook, available at mncourts.gov.

We are happy to answer any questions you have about the process.

Review

Review & submit

A summary of your intake. Use the edit links to jump back to any section. When ready, sign and date below to send your intake to our office.

Acknowledgement

By submitting this intake you confirm that the information provided is accurate to the best of your knowledge and that you understand this questionnaire does not by itself create an attorney-client relationship.

Signature (type your name)

Date

Guardianship & Conservatorship Intake Form

Your information

The Respondent

Interested persons — spouse & household

Interested persons — children & family

Institutions & existing documents

Information about the Respondent — status & benefits

Information about the Respondent — income & support

Respondent's assets & debts

Proposed Guardian(s)/Conservator(s)

Supporting documents

Training & resources

Review & submit

Start over?

Intake file ready