Legal Order of Incompetency

LEGAL ORDER OF INCOMPETENCY

Court:   County:   Case No.:

Petitioner:   Respondent:

Hearing date:   Judge presiding:

RECITALS

WHEREAS, Petitioner filed a sworn petition on alleging that Respondent lacks the capacity to manage the Respondent's person and/or estate; and

WHEREAS, notice of the hearing was given and an opportunity to be heard was afforded to the Respondent and to all persons entitled to notice in accordance with applicable law; and

WHEREAS, the Court received testimony, medical affidavits and other evidence, and the Court considered the least restrictive alternative and the statutory factors required for a determination of incompetency.

NOW, THEREFORE, IT IS ORDERED

1. FINDINGS OF FACT

The Court finds by clear and convincing evidence that Respondent, whose date of birth is and whose primary residence is , is unable to understand the nature and consequences of decisions regarding the Respondent's person and/or estate, and that the Respondent's condition substantially impairs the Respondent's ability to receive and evaluate information or to communicate decisions.

The Court finds that alternatives to the appointment of a conservator/guardian have been considered and are inadequate to meet the Respondent's needs as described in the record, including the assessment dated and the medical affidavits submitted by .

2. DETERMINATION OF INCOMPETENCY

Based on the foregoing findings, the Court determines that the Respondent is legally incompetent to manage the Respondent's person and/or estate. The Court further determines that it is in the Respondent's best interest to have a conservator/guardian appointed to make certain specified decisions on the Respondent's behalf.

3. APPOINTMENT

The Court appoints the following person as conservator/guardian for the Respondent:

Term of appointment begins on the effective date of this Order and continues until further order of this Court or until termination by operation of law.

4. POWERS AND DUTIES

The conservator/guardian is vested with the powers necessary to manage those aspects of the Respondent's person and estate as enumerated below. The conservator/guardian shall exercise only those powers expressly granted and in the least restrictive manner consistent with the Respondent's needs.

The Court grants the conservator the following specific powers (check boxes indicating conferred powers):

Medical decision-making authority including consent to treatment, admission to facility, and administration of medication as needed.

Management of financial affairs, including receipt of income, payment of bills, management of accounts, and initiation or defense of legal actions on behalf of the estate.

Authority to determine the Respondent's place of residence and to contract for residential services, subject to prior Court approval when placement is restrictive or long-term.

Authority to prosecute or defend legal claims on behalf of the Respondent's estate, obtain legal counsel, and enter into agreements necessary for estate administration.

5. LIMITATIONS AND CONDITIONS

The conservator/guardian shall exercise powers consistent with fiduciary duties including prudence, loyalty, and accounting. The conservator/guardian shall not sell or mortgage real property without prior Court authorization. Significant financial transactions in excess of shall require prior Court approval.

6. EMERGENCY AUTHORITY

If immediate action is required to prevent serious harm to the Respondent, the conservator/guardian is authorized to take reasonable emergency measures including temporary medical treatment and placement, provided that the conservator/guardian notifies the Court within days of taking such action and files a petition for ratification if required.

The Court further orders that this appointment is Limited    Plenary    Temporary/Emergency until

7. NOTICE, SERVICE, AND APPEARANCES

The Court finds that notice was given to all persons entitled to notice on . The Respondent was present in court: Yes    No.

8. BOND, ACCOUNTING, AND REPORTS

Unless waived for good cause, the conservator/guardian shall post bond in the sum of $ or as otherwise ordered by the Court. The conservator/guardian shall file an initial inventory and periodic accountings as required by law, reporting receipts, disbursements and current status of the estate.

9. TERMINATION, REVIEW, AND MODIFICATION

This Order may be reviewed or modified upon petition by any interested person, upon subsequent medical evidence showing restoration of capacity, or upon a change in circumstances. The conservator/guardian shall file reports and petitions for substitution or discharge when appropriate.

10. GOVERNING LAW

This Order is entered pursuant to applicable statutes and rules governing guardianship and conservatorship proceedings and shall be interpreted and enforced in accordance with the laws of the jurisdiction of this Court.

11. ENTIRE ORDER

This Order constitutes the entire order of the Court regarding the matters adjudicated herein and supersedes any prior provisional or interlocutory orders to the extent inconsistent.

12. SEVERABILITY

If any provision of this Order is held invalid or unenforceable, the remaining provisions shall remain in full force and effect to the extent consistent with the Court's findings and intent.

13. AMENDMENTS AND WAIVER

This Order may be amended only by further order of the Court. No waiver of any provision shall be effective unless memorialized in writing and approved by the Court.

IT IS SO ORDERED.

Entered this date:

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