FC FORM 104.1(F) Application to Commence Legal Proceedings for Ward

Guardianship of Case Number Court where lawsuit will be filed

Type of legal proceeding requested

personal injuryMalpracticeBreach of contractother

Specify other type of legal proceeding Summary of Facts line 1 Summary of Facts line 2 Summary of Facts line 3 Attorney Name Attorney Address Attorney Address line 2 Attorney telephone Attorney Email Address

Written attorney agreement

written attorney agreement Yeswritten attorney agreement No

Attorney fee arrangement

Hourly rateContingent percentage

Attorney hourly rate Attorney percentage rate