Fill and Sign the Physicians Affidavit Guardianship Delaware Form

IN THE COURT OF CHANCERY OF THE STATE OF DELAWARE IN AND FOR Please select a county In the Matter of: C.M.#             AN ALLEGED DISABLED PERSON PHYSICIAN'S AFFIDAVIT I,       , M.D., the physician of the alleged disabled person Physician's name Error: Reference source not found , do hereby depose and say that: alleged disabled person's name 1. I am a physician duly licensed to practice medicine in the State of Delaware. 2. The only relationship between the above named person and myself is that of physician and patient. 3. I last examined the aged, mentally infirmed and/or physically incapacitated person on this date       and in my medical opinion, he/she: (Check all that apply) Needs a Guardian of his/her Property because by reason of advanced age, mental infirmity and/or physical incapacity he/she is unable to properly manage and care for his/her property and in consequence thereof is in danger of dissipating or losing such property or of becoming a victim of designing persons AND Needs a Guardian of his/her Person because by reason of advanced age, mental infirmity and/or physical incapacity he/she is in danger of substantially endangering his/her health or becoming subject to abuse by other persons or becoming the victim of designing persons. 4. The particulars of the alleged advanced age, mental infirmity, and/or physical incapacity are set forth in detail as follows:       5. (Check the appropriate statement below. Check only ONE .) Personal notice of the Guardianship Petition by his/her attorney ad litem would NOT be detrimental to the person's health. Personal notice of the Guardianship Petition by his/her attorney ad litem WOULD be detrimental to the person's health for the following detailed reasons:       6. (Check the appropriate statement below. Check only ONE .) Personal notice of the Guardianship Petition by his/her attorney ad litem would NOT be meaningless. Personal notice of the Guardianship Petition by his/her attorney ad litem WOULD be meaningless for the following detailed reasons:       Date Physician's Signature SWORN TO AND SUBSCRIBED before me on this date: Notary Public or Clerk of the Court