Preview
Hearing Date: 5/2/2023 11:00 AM
Location: Court Room 1810
Judge: MacCain
199% 1/20)
FILED
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS 3/30/2023 3:32 PM
w-2023P 00% SR REPARTMENT — PROBATE DIVISION IRIS Y. MARTINEZ
F CIRCUIT CLERK
COOK COUNTY, IL
Estate of 2023P 002334
Calendar, 10
Adrienne Jeziorski 22096061
Alleged Person with a Disability
PETITION FOR APPOINTMENT OF GUARDIAN OF A PERSON WITH A DISABILITY
Does the Petitioner expect the Alleged Person With A Disability to appear in court? [| Yes (ml No
In accordance with §11a-8 of the Probate Act of 1975 (“Probate Act”) [755 ILCS 5/1la-8] and §§201 - 204 of the
Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act (“UAGPPJA”) [755 ILCS 8/201 - 204], the
Petitioner, Leonard J. Jeziorski
[printed name of the Petitioner]
states under the penalties of perjury:
1 Adrienne Jeziorski (the “Respondent”),
[printed name of the alleged person with a disability]
whose year of birth is 1955 , who is 18 years or older, who resides in Cook County, and whose
place of residence is 8849 S. Troy, Evergreen Park, IL 60805
, is a person with a disability;
[address/city/county/state/zip code]
The relationship to and interest in the Respondent of the Petitioner is Brother
*3. The reasons for the guardianship are that the Respondent is a person with a disability due to Cerebal Palsy
since birth causing signification cognitive disabilities and because of that disability
[description of disability]
(™ (@) lacks sufficient understanding or capacity to make or communicate responsible decisions concerning the
care of the Respondent’s person;
{™] (6) is unable to manage the Respondent's estate or financial affairs;
(a) The approximate value of the Respondent’s estate is: Personal $. 11,400.00 Real $00
(b) The amount of the Respondent’s anticipated annual gross income and other receipts are: $. 11,364.00
The names and post office addresses of the Respondent’s Guardian, if any, or of the Respondent’s agent(s) appointed
under any Power of Attorney Act, if any, and of the Respondent’s nearest relatives entitled to notice, are listed on
Exhibit A attached to this Petition “Nearest relatives” means, in the following order, (a) the spouse (including a
party to a civil union) and adult children, the parents and adult brothers and sisters or, if none, (b) the nearest adult
kindred known to the Petitioner;
The names and post office addresses of any minor or adult who is dependent upon the Respondent are also listed on
Exhibit A attached to this Petition.
The name and address of the person with whom, or the facility in which, the Respondent is residing is
Leonard J. Jeziorski, 8849 S. Troy, Evergreen Park, Illinois 60805
*8 {™ (a) No Petition for the appointment of a Guardian of the Respondent is pending in any other jurisdiction;
LJ (b) A Petition for the appointment of a Guardian of the Respondent is pending in
#40). {®] (@) Illinois is the Respondent’s “home state” as defined in §201(a)(2) of the UAGPPJA.
C1 @) is the Respondent’s “home state”, but Illinois is a “significant-connection state”
defined in §201(a)(3) of the UAGPPJA, and one of the additional requirements specified in §203(2)(A)-(B)
of UAGPPJA applies.
* Check the appropriate box or boxes
** Check the appropriate basis for jurisdiction
IRIS Y. MARTINEZ, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
Page | of 5
2023P 002334
CCP 0200 B (12/01/20) File No.
{1 (©) Illinois is not the Respondent’s “home state’ or a significant-connection state’ as defined in
§201(a)(2)-(3) of the UAGPPJA, but the “home state” and every “significant-connection state” have
declined to exercise jurisdiction because Illinois is the most appropriate forum.
LJ @ Illinois is not the Respondent’s “home state’ or a ‘significant-connection state’ as defined in
§201(a)(2)-(3) of the UAGPPJA, but the circumstances involved constitute an “emergency” as defined
in §201(a)(1) of the UAGPPJA, and, as a result, the Court has “special jurisdiction” under §204(a) of the
UAGPPJA,
The Petitioner asks that Adrienne Jeziorski be adjudged a person with a disability, and that
[printed name of the Respondent]
A Leonard J. Jeziorski
[printed name of the proposed Guardian]
8849 S. Troy, Evergreen Park, Illinois 60805
[post office address/city/state/zip code]
age 68 years. brother Caregiver
[relationship to the Respondent] [occupation]
who is qualified and willing to act and who has not been convicted of a felony, be
(has) (has not)
appointed as Guardian of the estate and person of the Respondent.
(estate and person) (estate only)
whe
[printed name of the proposed Guardian]
[post office address/city/state/zip code]
age years, »
[relationship to the Respondent] [occupation]
who is qualified and willing to act and who been convicted of a felony, be
(has) (has not)
appointed as Guardian of the person only of the Respondent.
HEC.
[printed name of the proposed Guardian]
be appointed even though has been convicted of a felony because
(he) (she)
(i) the appointment is in the Respondent’s best interests, after considering the nature and date of the offense
and the evidence of the proposed Guardian’s rehabilitation, and
(ii) the offense is not one which, under §11a-5(5) of the Probate Act, would prohibit the appointment.
*** Strike if not applicable.
load”big
ign; (if
fare of the Wes
Attorney Number 38477
8849 S. Troy
Name Paul A. Smolinski [address of the Petitioner]
Firm Name Palos Elder Law, Ltd
Evergreen Park, IL 60805
Attorneys for Leonard J. Jeziorski [city/state/zip code]
Service via Email will be accepted at:
Address 19550 S. Harlem Ave., Suite 2
City/State/Zip Frankfort, IL 60423-6730 by ee eet£0 Tl. ee and 131
Telephone 708-371-9500
~ chins C&ftification
Email Paul@paloselderlaw.com
IRIS Y. MARTINEZ, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
Page 2 of S
2023P 002334
CCP 0200 C (12/01/20) File No.
Exepair A
Attached to and made a part of a
PETITION FOR APPOINTMENT OF GUARDIAN OF A PERSON WITH A DISABILITY
List the names and post office addresses (i) of the persons entitled to receive notice under paragraph 5, and (ii)
of the minors or adults who are dependent upon the Respondent under paragraph 6, of the Petition to which this
Exhibit A is attached.
J. Respondent’s Guardian(s) or agent(s) appointed under the Illinois Power of Attorney Act
Has a Court appointed a Guardian for the Respondent? (Yes [i] No (] Unknown
Has the Respondent executed a Power of Attorney for Property? (g) Yes []No [| Unknown
Has the Respondent executed a Power of Attorney for Health Care? (Yes [JNo [] Unknown
Provide the following information with respect to each Guardian and agent:
Leonard J, Jeziorski
[name] iname]
8849 S. Troy
[address] [address]
Evergreen Park, IL 60805
[city/state/zip} [city/state/zip]}
Brother
[relationship fo the Respondent] [relationship to the Respondent]
708-890-8493 N/A
[telephone] [email] [telephone] [email]
Type of guardianship: Type of Power of Attorney: Type of guardianship: ‘Type of Power ofAttorney
Cladult (Minor ™ Property Cladutt (Minor L) Property
(]Person CiEstate {Health Care (]Person LJEstate (Health Care
If the Respondent has one or more additional Guardian(s) or agent(s), provide the above information with
respect to each on an additional page.
II. Respondent’s Nearest Relatives Entitled to Notice
A. Does the Respondent have a spouse (by marriage or civil union) and adult children, parents and adult
brothers and sisters living?
Tf “No” or “Unknown”, proceed to paragraph B below.
If “Yes”, provide the following information with respect to each:
Spouse Adult Child
Not Applicable Not Applicable
[name] [ame]
[address] [address]
[city/state/zip] [eity/state/zip]
[telephone] [email] [ielephone] [email]
TRIS Y. MARTINEZ, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
Page 3 of 5
2023P 002334
CCP 0200 D (12/01/20) File No.
Adult Child Adult Child
[name] Thame]
[address] [address]
a
ao [city/state/zip] [cityistate/zip]
7
6
[ielephone} [email] [telephone] [email]
Ss
If the Respondent has one or more additional adult children living, provide the above information with respect
to each on an additional page.
Parent Parent
Deceased
[name] jname]
[address] [address]
[city/state/zip] [cityAstate/zip]
[ielephone] [email] [telephone] [email]
Adult Brother or Sister Adult Brother or Sister
Leonard J. Jeziorski
[name] [name]
8849 S. Troy
[address] [address]
Evergreen Park, IL.
[city/state/zip] [city/state/zip]
708-890-8493 N/A
[telephone] [email] [relephone} [email]
If the Respondent has one or more additional adult brothers and sisters living, provide the above information
with respect to each on an additional page.
B. Ifthe Respondent has no spouse, no adult child, no parent and no adult brother or sister, provide the fol-
lowing information with respect to each nearest adult relative:
fname] [relationship] [name] [relationship]
[address] [address]
[cityistate/zip] [city/state/zip]
[telephone] [email] [iclephone] [email]
IRIS Y. MARTINEZ, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
Page 4 of 5
2023P 002334
CCP 0200 E (12/01/20) File No.
[name] [relationship] [name] [relationship]
[address] [address]
[eity/state/zip] [city/state/zip]
[felephone] [email] [ielephone} [email]
If the Respondent has one or more additional adult relatives living, provide the above information with respect
to each on an additional page.
UII. Minor(s) and Adult(s) Dependent Upon the Respondent
Does the Respondent have one or more minors or adults who are dependent upon the Respondent?
(1 Yes [i] No () Unknown
If “Yes”, provide the following information with respect to each:
Dependent (1 Minor CJAdult Dependent C] Minor CJAdult
fname] [relationship] [name] [relationship]
[address] [address]
[city/state/zip] [eity/state/zip}
[telephone] [email] [telephone] [email]
If the Respondent has one or more additional adult relatives living, provide the above information with respect
to each on an additional page.
IRIS Y. MARTINEZ, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
Page 5 of 5
Preview
Hearing Date: 5/2/2023 11:00 AM Location: Court Room 1810 Judge: MacCain 199% 1/20) FILED IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS 3/30/2023 3:32 PM w-2023P 00% SR REPARTMENT — PROBATE DIVISION IRIS Y. MARTINEZ F CIRCUIT CLERK COOK COUNTY, IL Estate of 2023P 002334 Calendar, 10 Adrienne Jeziorski 22096061 Alleged Person with a Disability PETITION FOR APPOINTMENT OF GUARDIAN OF A PERSON WITH A DISABILITY Does the Petitioner expect the Alleged Person With A Disability to appear in court? [| Yes (ml No In accordance with §11a-8 of the Probate Act of 1975 (“Probate Act”) [755 ILCS 5/1la-8] and §§201 - 204 of the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act (“UAGPPJA”) [755 ILCS 8/201 - 204], the Petitioner, Leonard J. Jeziorski [printed name of the Petitioner] states under the penalties of perjury: 1 Adrienne Jeziorski (the “Respondent”), [printed name of the alleged person with a disability] whose year of birth is 1955 , who is 18 years or older, who resides in Cook County, and whose place of residence is 8849 S. Troy, Evergreen Park, IL 60805 , is a person with a disability; [address/city/county/state/zip code] The relationship to and interest in the Respondent of the Petitioner is Brother *3. The reasons for the guardianship are that the Respondent is a person with a disability due to Cerebal Palsy since birth causing signification cognitive disabilities and because of that disability [description of disability] (™ (@) lacks sufficient understanding or capacity to make or communicate responsible decisions concerning the care of the Respondent’s person; {™] (6) is unable to manage the Respondent's estate or financial affairs; (a) The approximate value of the Respondent’s estate is: Personal $. 11,400.00 Real $00 (b) The amount of the Respondent’s anticipated annual gross income and other receipts are: $. 11,364.00 The names and post office addresses of the Respondent’s Guardian, if any, or of the Respondent’s agent(s) appointed under any Power of Attorney Act, if any, and of the Respondent’s nearest relatives entitled to notice, are listed on Exhibit A attached to this Petition “Nearest relatives” means, in the following order, (a) the spouse (including a party to a civil union) and adult children, the parents and adult brothers and sisters or, if none, (b) the nearest adult kindred known to the Petitioner; The names and post office addresses of any minor or adult who is dependent upon the Respondent are also listed on Exhibit A attached to this Petition. The name and address of the person with whom, or the facility in which, the Respondent is residing is Leonard J. Jeziorski, 8849 S. Troy, Evergreen Park, Illinois 60805 *8 {™ (a) No Petition for the appointment of a Guardian of the Respondent is pending in any other jurisdiction; LJ (b) A Petition for the appointment of a Guardian of the Respondent is pending in #40). {®] (@) Illinois is the Respondent’s “home state” as defined in §201(a)(2) of the UAGPPJA. C1 @) is the Respondent’s “home state”, but Illinois is a “significant-connection state” defined in §201(a)(3) of the UAGPPJA, and one of the additional requirements specified in §203(2)(A)-(B) of UAGPPJA applies. * Check the appropriate box or boxes ** Check the appropriate basis for jurisdiction IRIS Y. MARTINEZ, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page | of 5 2023P 002334 CCP 0200 B (12/01/20) File No. {1 (©) Illinois is not the Respondent’s “home state’ or a significant-connection state’ as defined in §201(a)(2)-(3) of the UAGPPJA, but the “home state” and every “significant-connection state” have declined to exercise jurisdiction because Illinois is the most appropriate forum. LJ @ Illinois is not the Respondent’s “home state’ or a ‘significant-connection state’ as defined in §201(a)(2)-(3) of the UAGPPJA, but the circumstances involved constitute an “emergency” as defined in §201(a)(1) of the UAGPPJA, and, as a result, the Court has “special jurisdiction” under §204(a) of the UAGPPJA, The Petitioner asks that Adrienne Jeziorski be adjudged a person with a disability, and that [printed name of the Respondent] A Leonard J. Jeziorski [printed name of the proposed Guardian] 8849 S. Troy, Evergreen Park, Illinois 60805 [post office address/city/state/zip code] age 68 years. brother Caregiver [relationship to the Respondent] [occupation] who is qualified and willing to act and who has not been convicted of a felony, be (has) (has not) appointed as Guardian of the estate and person of the Respondent. (estate and person) (estate only) whe [printed name of the proposed Guardian] [post office address/city/state/zip code] age years, » [relationship to the Respondent] [occupation] who is qualified and willing to act and who been convicted of a felony, be (has) (has not) appointed as Guardian of the person only of the Respondent. HEC. [printed name of the proposed Guardian] be appointed even though has been convicted of a felony because (he) (she) (i) the appointment is in the Respondent’s best interests, after considering the nature and date of the offense and the evidence of the proposed Guardian’s rehabilitation, and (ii) the offense is not one which, under §11a-5(5) of the Probate Act, would prohibit the appointment. *** Strike if not applicable. load”big ign; (if fare of the Wes Attorney Number 38477 8849 S. Troy Name Paul A. Smolinski [address of the Petitioner] Firm Name Palos Elder Law, Ltd Evergreen Park, IL 60805 Attorneys for Leonard J. Jeziorski [city/state/zip code] Service via Email will be accepted at: Address 19550 S. Harlem Ave., Suite 2 City/State/Zip Frankfort, IL 60423-6730 by ee eet£0 Tl. ee and 131 Telephone 708-371-9500 ~ chins C&ftification Email Paul@paloselderlaw.com IRIS Y. MARTINEZ, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 2 of S 2023P 002334 CCP 0200 C (12/01/20) File No. Exepair A Attached to and made a part of a PETITION FOR APPOINTMENT OF GUARDIAN OF A PERSON WITH A DISABILITY List the names and post office addresses (i) of the persons entitled to receive notice under paragraph 5, and (ii) of the minors or adults who are dependent upon the Respondent under paragraph 6, of the Petition to which this Exhibit A is attached. J. Respondent’s Guardian(s) or agent(s) appointed under the Illinois Power of Attorney Act Has a Court appointed a Guardian for the Respondent? (Yes [i] No (] Unknown Has the Respondent executed a Power of Attorney for Property? (g) Yes []No [| Unknown Has the Respondent executed a Power of Attorney for Health Care? (Yes [JNo [] Unknown Provide the following information with respect to each Guardian and agent: Leonard J, Jeziorski [name] iname] 8849 S. Troy [address] [address] Evergreen Park, IL 60805 [city/state/zip} [city/state/zip]} Brother [relationship fo the Respondent] [relationship to the Respondent] 708-890-8493 N/A [telephone] [email] [telephone] [email] Type of guardianship: Type of Power of Attorney: Type of guardianship: ‘Type of Power ofAttorney Cladult (Minor ™ Property Cladutt (Minor L) Property (]Person CiEstate {Health Care (]Person LJEstate (Health Care If the Respondent has one or more additional Guardian(s) or agent(s), provide the above information with respect to each on an additional page. II. Respondent’s Nearest Relatives Entitled to Notice A. Does the Respondent have a spouse (by marriage or civil union) and adult children, parents and adult brothers and sisters living? Tf “No” or “Unknown”, proceed to paragraph B below. If “Yes”, provide the following information with respect to each: Spouse Adult Child Not Applicable Not Applicable [name] [ame] [address] [address] [city/state/zip] [eity/state/zip] [telephone] [email] [ielephone] [email] TRIS Y. MARTINEZ, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 3 of 5 2023P 002334 CCP 0200 D (12/01/20) File No. Adult Child Adult Child [name] Thame] [address] [address] a ao [city/state/zip] [cityistate/zip] 7 6 [ielephone} [email] [telephone] [email] Ss If the Respondent has one or more additional adult children living, provide the above information with respect to each on an additional page. Parent Parent Deceased [name] jname] [address] [address] [city/state/zip] [cityAstate/zip] [ielephone] [email] [telephone] [email] Adult Brother or Sister Adult Brother or Sister Leonard J. Jeziorski [name] [name] 8849 S. Troy [address] [address] Evergreen Park, IL. [city/state/zip] [city/state/zip] 708-890-8493 N/A [telephone] [email] [relephone} [email] If the Respondent has one or more additional adult brothers and sisters living, provide the above information with respect to each on an additional page. B. Ifthe Respondent has no spouse, no adult child, no parent and no adult brother or sister, provide the fol- lowing information with respect to each nearest adult relative: fname] [relationship] [name] [relationship] [address] [address] [cityistate/zip] [city/state/zip] [telephone] [email] [iclephone] [email] IRIS Y. MARTINEZ, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 4 of 5 2023P 002334 CCP 0200 E (12/01/20) File No. [name] [relationship] [name] [relationship] [address] [address] [eity/state/zip] [city/state/zip] [felephone] [email] [ielephone} [email] If the Respondent has one or more additional adult relatives living, provide the above information with respect to each on an additional page. UII. Minor(s) and Adult(s) Dependent Upon the Respondent Does the Respondent have one or more minors or adults who are dependent upon the Respondent? (1 Yes [i] No () Unknown If “Yes”, provide the following information with respect to each: Dependent (1 Minor CJAdult Dependent C] Minor CJAdult fname] [relationship] [name] [relationship] [address] [address] [city/state/zip] [eity/state/zip} [telephone] [email] [telephone] [email] If the Respondent has one or more additional adult relatives living, provide the above information with respect to each on an additional page. IRIS Y. MARTINEZ, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 5 of 5