Legal Care Petition Form

LEGAL CARE PETITION FORM

Petitioner Name: , Petitioner Address: , Petitioner Telephone: , Petitioner Email: .

Proposed Ward Name: , Proposed Ward Address: , Date of Birth: , County of Residence: .

RECITALS

WHEREAS, Petitioner alleges that the Proposed Ward described above is an adult who, by reason of an impairment in cognitive or functional capacity, is incapable of effectively providing for the Ward's personal needs for physical health, food, clothing, shelter, or safety, and therefore requires appointment of a legally authorized decision-maker.

WHEREAS, Petitioner seeks appointment of a guardian and/or conservator to make decisions on behalf of the Proposed Ward limited to the scope requested below, and has determined that appointment is necessary to protect the health, safety, and property of the Proposed Ward.

WHEREAS, the Proposed Guardian identified for appointment is willing and able to serve and is believed to have the capacity, suitability, and background necessary to discharge the duties of guardian and/or conservator.

NOW, THEREFORE, Petitioner respectfully petitions the Court for the relief set forth herein and alleges as follows:

1. COURT AND CASE IDENTIFICATION

2. JURISDICTION AND VENUE

This Court has jurisdiction over the subject matter of this petition and venue is proper in this county because the Proposed Ward is a resident of this county and the matters alleged herein arose in this county.

3. ALLEGATIONS OF INCAPACITY

Petitioner alleges that the Proposed Ward suffers from the following conditions, behaviors, or diagnoses that substantially impair the Ward's ability to manage personal or financial affairs (summarize facts, observations, and incidents supporting incapacity):

Known or suspected causes of incapacity and relevant medical history (including dementia, stroke, traumatic brain injury, psychiatric diagnosis, or other conditions):

4. PROPOSED GUARDIAN/CONSERVATOR

Proposed Guardian Name: , Address: , Relationship to Proposed Ward: .

Proposed Guardian's qualifications, experience, and reasons for appointment (brief statement of suitability):

5. POWERS REQUESTED

Petitioner requests that the Court grant the Proposed Guardian the following powers (check all that apply and specify any limitations):

Authority to make medical and healthcare decisions, including consent to treatment, placement, and end-of-life decisions consistent with applicable law.

Authority to manage financial affairs, access accounts, pay bills, contract for services, and take actions reasonably necessary to preserve and administer the Ward's estate.

Authority to determine residence and custodial arrangements, including placement in supportive or assisted-living facilities when necessary for the Ward's welfare.

Authority to consent to legal matters, education, and other specified matters:

6. MEDICAL EVIDENCE

The following health care providers or evaluators have examined the Proposed Ward and have been asked to provide written or oral reports to the Court:

Petitioner will file or cause to be filed all medical and capacity evaluations in support of this petition and requests that the Court consider those reports in determining the existence and extent of incapacity.

7. NOTICE TO INTERESTED PERSONS

Petitioner certifies that, to the best of Petitioner's knowledge, the following persons are interested parties entitled to notice under applicable law. Provide name, relationship, and current address:

8. EMERGENCY RELIEF (IF APPLICABLE)

Petitioner requests temporary emergency appointment of a guardian or conservator pending full hearing.

If emergency relief is requested, state the specific emergency facts and the duration of the temporary appointment sought:

9. BOND AND SECURITY

Petitioner requests that the Court:

Require issuance of a bond in the amount of $ to secure the faithful performance of fiduciary duties.

Waive bond for the Proposed Guardian for good cause shown and to the extent permitted by law.

10. ACCOUNTING AND SUPERVISION

The Proposed Guardian shall render periodic accountings and reports to the Court as required by statute and the Court's order. Petitioner requests that the Court set a schedule for reporting, including initial inventory, periodic accountings, and annual reports as appropriate.

11. RIGHTS OF THE WARD

Petitioner acknowledges the rights of the Proposed Ward to notice, to counsel, to participate in the hearing, to present evidence, to cross-examine witnesses, and to appeal any adverse determination. Petitioner requests that the Court ensure these rights are afforded.

12. TERMINATION, AMENDMENT, AND MISCELLANEOUS PROVISIONS

Termination: Appointment shall terminate upon the death of the Ward, restoration of capacity, resignation accepted by the Court, or further order of the Court.

Amendments and Waiver: This petition may be amended by leave of Court. No waiver by any party of any provision of this petition shall be binding unless in writing and signed by the waiving party.

Counterparts and Execution: This petition may be executed in counterparts and facsimile or electronic signatures shall be accepted to the extent permitted by Court rules.

13. GOVERNING LAW; SEVERABILITY; ENTIRE PETITION

Governing Law: This petition shall be governed by the laws of the state in which the Court is located. Any interpretation of this petition shall be consistent with applicable statutory provisions governing guardianship and conservatorship.

Severability: If any provision of this petition is held invalid, the remaining provisions shall remain in full force and effect.

Entire Petition: This document constitutes the entire written petition seeking appointment and supersedes prior written or oral statements to the extent inconsistent.

14. NOTICE

VERIFICATION

I, the undersigned Petitioner, declare under penalty of perjury under the laws of the governing jurisdiction that the foregoing statements are true and correct to the best of my knowledge and belief, and that I believe the Proposed Ward to be incapacitated as described above.

Executed this day of , .

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