Fill and Sign the Petition Restoration Form

Petition for the Restoration of an Individual Found to Be in Need of a Guardian and/or Conservator INSTRUCTIONS I. Specific Instructions 1. This form is to be used for filing a Petition for the Reinstatement of a Ward (formerly Incapacitated Adult) pursuant to O.C.G.A. §29- 4-42 and O.C.G.A. §29-5-72. 2. The burden of proof is on the petitioner to show by a preponderance of the evidence that there is no longer a need for a guardianship and/or conservatorship. II. General Instructions General instructions applicable to all Georgia probate court standard forms appear in Volume 255 of the Georgia Reports and are available in each probate court. Effective 7/07 GPCSF 65Petitioner PROBATE COURT OF COUNTY STATE OF GEORGIA IN RE: ) ESTATE NO. ) , ) PETITION FOR RESTORATION OF WARD ) AN INDIVIDUAL FORMERLY FOUND TO ) BE IN NEED OF A GUARDIAN AND/OR ) CONSERVATOR TO THE HONORABLE JUDGE OF THE PROBATE COURT: [NOTE: Unless there are two or more petitioners, the affidavit on page 9 must be completed by a physician, psychologist, or licensed clinical social worker based upon an examination within 15 days prior to the filing of this petition.] 1. Petitioner, , is a. the Ward b. the (relationship) of the ward, and is domiciled at (address) ________________________________________________ County, State of , telephone number , and (Initial either a. or b. below): a. ( (address Second Petitioner, if any) _________________________________________, is the (relationship) of the ward, and is domiciled at (address) County, State of telephone number , show that or b. attached hereto as page 4 and made a part of this petition is the completed affidavit of , a physician or psychologist licensed to practice in Georgia or a licensed clinical social worker, who has examined the ward within fifteen days prior to the filing of this petition, show that: Effective 7/07 GPCSF 65Petitioner- 2 - 2. The ward is domiciled at (address) __________________________________________________ _______________________County, State of , and is presently located at __________________________________________________________________________________, and can be contacted at (telephone number): . 3. The proposed ward no longer is in need of a guardian and/or conservator because: (NOTE: the Petition cannot be granted unless sufficient facts are presented which support the claim for the restoration of the Ward. While an attached physician’s/psychologist’s/social worker’s affidavit is permissible, the Petitioner(s) MUST specifically allege sufficient facts to support the granting of this Petition.) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 4. (Name(s) or n/a) ________________________________________________________________ _________________ currently serve(s) as the guardian and (Name(s) or n/a)____________________ as the conservator. 5. Additional Data: Where full particulars are lacking, state here the reasons for any such omission. Effective 7/07 GPCSF 65Petitioner- 3 - WHEREFORE, petitioner(s) pray(s): 1. that service be perfected as required by law; 2. that the court appoint legal counsel and an evaluator for the ward and order an evaluation as required by law; 3. that upon receipt of the evaluation report, the court order a hearing to determine the continued need for a guardian and/or conservator for the ward; and 4. that the ward’s rights be restored. _________________________________ Signature of first petitioner Signature of second petitioner, if any _________________________________ Printed Name Printed Name ________________________________ Address Address _________________________________ _________________________________ Telephone Number Telephone Number Signature of Attorney: _________________________________ Typed/printed name of Attorney: _________________________________ Address: _________________________________ _________________________________ Telephone: State Bar #____________ VERIFICATION GEORGIA, COUNTY Personally appeared before me the undersigned petitioner(s) who on oath state(s) that the facts set forth in the foregoing petition are true. Sworn to and subscribed before me this day of , 20 . _________________________________ First Petitioner _________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name My Commission Expires ------------------------------------------------------------------------------------------------------------------------------ Sworn to and subscribed before me this day of , 20 . __________________________________ Second Petitioner, if any __________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name My Commission Expires STATE OF GEORGIA Effective 7/07 GPCSF 65Petitioner- 4 - COUNTY OF ______________________________ PROBATE COURT OF COUNTY Effective 7/07 GPCSF 65Petitioner- 5 - RE: Petition for RESTORATION of , a Ward. AFFIDAVIT OF PHYSICIAN, PSYCHOLOGIST , OR LICENSED CLINICAL SOCIAL WORKER I, being first duly sworn, depose and say that I am a physician licensed to practice under Chapter 34 of Title 43 of the Official Code of Georgia Annotated, a psychologist licensed to practice under Chapter 39 of Title 43 of the Official Code of Georgia Annotated, or a Licensed Clinical Social Worker; that my office address is _______________________________________________________, Georgia, that I have examined the above-named ward on the day of , 20 , and that I found him/her to (initial all applicable): a. (for restoration regarding guardianship:) now have sufficient capacity to make or communicate significant responsible decisions concerning his/her health or safety. b. (for restoration regarding conservatorship:) now have sufficient capacity to make or communicate significant responsible decisions concerning the management of his/her property. c. (for retention of guardianship:) still lack sufficient capacity to make or communicate significant responsible decisions concerning his/her health or safety. d. (for retention of conservatorship:) still lack sufficient capacity to make or communicate significant responsible decisions concerning the management of his/her property. The following facts support said diagnosis: - 6 - (RESTORATION FORM, cont.) WITNESS MY HAND AND SEAL this day of , 20 . Sworn to and subscribed before me this day of , 20 . _____________________________________________ Signature of (Physician)(Psychologist)(Social Worker) _________________________________ Notary Public My commission expires on the day Typed Name__________________________________ of , 20 . (NOTARIAL SEAL AFFIXED) NOTE: The examination on which this affidavit is based must occur WITHIN FIFTEEN DAYS prior to the filing of the petition. - 7 -