Vermont > Statewide > Probate Court
Petition For Appointment Of Guardian For An Adult 72 - Vermont
| Petition For Appointment Of Guardian For An Adult Form. This is a Vermont form and can be used in Probate Court Statewide . |
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Probate Court Form No. 72 STATE OF VERMONT DISTRICT OF ______________, SS. PROBATE COURT DOCKET NO.____________________ GUARDIANSHIP OF:___________________________________ OF:____________________________________ PETITION FOR APPOINTMENT OF GUARDIAN FOR AN ADULT PERSON The undersigned (petitioner) represents that it is necessary that a guardian be appointed for the following individual (respondent): Name ______________________________ Residence Address _______________________________ _______________________________ (Current location if different from above)______________________________________ In support of this petition, the undersigned provides the following: A. The name and address of anyone known to the petitioner who is: Currently serving as a guardian (Attach a copy of appointment) _________________________________________________________________ Currently named as Agent in an Advance Directive document (Attach a copy) __________________________________________________________________ Currently acting as Agent under a Power of Attorney document (Attach a copy) __________________________________________________________________ B. The petitioner's relationship to the respondent is (check one): friend/neighbor social worker C. public official physician relative________________ other (attach explanation)_____________ DOB _________ The respondent is alleged to be a person in need of guardianship, is at least 18 years of age or will be within four months of the filing of the petition, and is disabled from (check one): Mental Illness Developmental Disability Other______________ Traumatic Brain Injury D. List specific reasons with supporting facts as to why guardianship is sought: American LegalNet, Inc. www.FormsWorkFlow.com E. The petitioner requests the following powers (check all that apply): To exercise general supervision over the person under guardianship, including care, habilitation, education, and employment. To give or withhold consent to medical or dental treatment, subject to the provisions of T. 14 VSA §3075, and any constitutional rights of the person under guardianship to refuse treatment; To exercise financial supervision over the income and resources of the person under guardianship; To approve or withhold approval of any contract, except for necessities, which the person under guardianship wishes to make; To approve or withhold approval of the sale or encumbrance of real property of the person under guardianship subject to the provisions of T. 14 VSA §2881, et seq.; To obtain legal advice and to commence or defend against court actions in the name of the person under guardianship. F. G. Have other alternatives to guardianship been considered? If yes, please explain:________________________________________________________________________ Name and address of proposed guardian: Telephone: The undersigned understands that the Court must order an evaluation of the respondent to be performed by someone who has specific training and demonstrated competence to evaluate a person in need of guardianship. The evaluation shall be completed within 30 days of the filing of the petition with the court unless the time period is extended by the court for cause. Name and address of evaluator: The undersigned understands that the Court must appoint an attorney to represent the respondent in this proceeding. Name and address of the respondent's attorney, if any: Dated________________ Signed____________________________, Petitioner Print name__________________________________ Address_____________________________________ ____________________________________________ ____________________________________________ Telephone I CONSENT TO BE APPOINTED GUARDIAN OF THE ABOVE RESPONDENT Signature of proposed guardian:_____________________________ Date: __________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Attachments as follows: 1. 2. 3. 4. 5. $ .00 entry fee, payable to ______________Probate Court Statement of proposed respondent's assets and income (Form No. 73) List of interested persons (Form No. 75) Copy of advance directive and/or any power of attorney You also may be required to submit consents necessary for a complete background check. Guardianship shall be utilized only as necessary to promote the well-being of the individual and to protect the individual from violations of his or her human and civil rights. It shall be designed to encourage the development and maintenance of maximum self-reliance and independence in the individual and only the least restrictive form of guardianship shall be ordered to the extent required by the individual's actual mental and adaptive limitations. The state of Vermont recognizes the fundamental right of an adult with capacity to determine the extent of health care the individual will receive. 14 VSA § 3060. American LegalNet, Inc. www.FormsWorkFlow.com
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