2013-10-31_GENERAL DOCUMENTS - C1981014

• Permit No: C1981014
• IBM Index Class Name: General Documents
• Doc Date: 10/31/2013
• Doc Name: Motion for Leave ‎(Emailed)‎
• From: Peter Coulter
• To: David Berry
• Permit Index Doc Type: General Correspondence
• Email Name: DAB
• Email Name: RDZ
• Email Name: JHB
• Email Name: DIH
• Media Type: D
• Archive: No

13. Does the Respondent currently have a guardian? UYes IMNo If Yes, identify:
Name: Concurrent petition pending by this petitioner
Curre.r` Residence;
City:
Home Phone #:
state: Z;p Dude: EmaitAddress:
Work Phone #:
14. Informaitlon on adult C'hildr'en and parents. JNone If None, list an Edilt relative, fDr example brother,
sister, agar:, uncle that can be found witr efforts:
Name: Paula Coulter_ Relationship` ®Adult Child or E3 Parent
Address: 1041 Field Itreet
City: Lakewood State: CO7----..-_ZipCode: 80215 Email Address: paulacoulter(MComcast.n t
Home Phone M (3033 238 -9197 Work Phone*
Name: Thtgdcre Coulter Relationship; OAdult Child or LIParent
Address: 19214 Lovers Lane
City: Grey Fore$L_ State: 12�_Zip Code. 78023 Ernail Andress: tedcoulterayehoo.com
Home Phone #: i21D) 695 -5994 Mobile Phone * 12103 379 -4367
Name: Peter Joseph Stein Coulter Relationship. Adult Child
Address: Post Office Box 3084 _
City: Vail State: c0 Zip Code: 91658 Email Address: [e-mail]
Home Phone #: Work Phone �
18. Did the Respondent have a person who had primary care and custody during the 60 days prier to the
flung of this Petition? MYes UNo If Yes, identify:
Name: Respondent is a resident at Atria Inrt at Lakewood
Relationship to Respondent: Care facility
Current Residence: 555 S Pierce St., Apt. 111 _
City: Lakewood State: g_Q Zip Code: 80226 Email Address:
Home Phone #: [phone]{3 .__VVcrk Phone#:
Iii. Does the Respondent have any legal representative(s)? Uyes X1 No if Yes, ide -iffy:
Marne:
Current Residence:
Phone P
City: State: _Zip Code. Email Address:
Name: Phone #:
Clement Residence:
20