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2. Instructions

   1. You can file a complaint about a guardianship/conservatorship or a guardian/ conservator if you don’t have a lawyer.

   2. The Guardianship/Conservatorship Complaint is an optional form. You may use this form or you may write a letter. Either way, the complaint goes to the court.

   3. Complete this form or your letter with as much information as you can provide to explain your complaint to the court.

   4. Give your complaint to the superior court where the guardianship/ conservatorship is filed. Give your document to:

   Jessica Humphreys

   Superior Court Director

   128 N 2nd Street

   Yakima, WA 98908

   Jessica.Humphreys@co.yakima.wa.us

   509.574.2710

    

   5. If you want more information about the law on complaints, see RCW 11.130.140.

6. 1. Complaint

   Person making the complaint

8. First Name*
9. Last Name*
11. Address*
13. City*
14. State*
15. Zip Code*
17. Email*
18. Phone Number*
20. Relationship to Individual*

24. 2. Individual Subject to Guardianship/Conservatorship (Individual)

26. First Name*
27. Last Name*
29. Address*
31. City*
32. State*
33. Zip Code*
35. County in which case is filed*
36. Case Number

    (located on the upper right corner of court paperwork, if you know it)

40. 3. Guardian/Conservator

42. Name of Guardian/Conservator*

46. 4. Describe Your Complaint

48. Describe your concerns below. Please be as specific as possible. Include dates and places if you can. Please do not attach confidential reports, personal health care records, or financial source documents. To ensure their privacy, attach such documents to the Sealed Cover Sheet – Guardianship/Conservatorship Document, form GDN ALL 001, and give the court the cover sheet and documents with your complaint*

52. 4. Other people with information

    Please list other people such as family members, friends, facility staff, or other professionals who have information about the incident(s) you described.

54. Person 1
55. Relationship to Individual:
57. Person 2
58. Relationship to Individual:
60. Person 3
61. Relationship to Individual:
63. Person 4
64. Relationship to Individual:
66. Person 5
67. Relationship to Individual:

73. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. 

75. Signed at*

    City, State

76. Date*
    Date
78. Signature*

    Your typed name will serve as your signature.

Leave This Blank:


80. 1. Receive an email copy of this form.
81. Email address

    This field is not part of the form submission.

82. Submit

* indicates a required field