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Petition For Voluntary Reprsentation By Conservator PC-301 - Connecticut

Petition For Voluntary Reprsentation By Conservator Form. This is a Connecticut form and can be used in Probate Statewide .
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PETITION FOR VOLUNTARY STATE OF CONNECTICUT RECORDED: REPRESENTATION BY CONSERVATOR PC-301 REV. 7/13 Page 1 COURT OF PROBATE [Type or print in ink. Complete Confidential Information Sheet for PC-301 on last page.] TO: COURT OF PROBATE, IN THE MATTER OF [Name, address and telephone number.] Hereinafter referred to as the petitioner. DATE OF BIRTH DISTRICT NO. SPOUSE [Name, address and telephone number] PERSONS TO WHOM NOTICE SHOULD BE GIVEN: SPOUSE and CLOSEST RELATIVES [If none, so state. Give names, addresses and relationships to petitioner. Indicate anyone who is a minor, in the military service, or under conservatorship or legal disability. For any party who has been adjudicated incapable, include name, address and position of trust of the legal representative.] C.G.S. § 45a-646. [To give further details, use Second Sheet, PC-180.] The petitioner states that the following efforts have been made to identify or locate any party whose name and/or address is unknown: THE PETITIONER REPRESENTS that he/she: Is now living at the present address written above and has domicile in the town written above. Has Has not executed a living will. Has Has not appointed a health care representative. [Include name and address. If unknown, so state.]* Has Has not appointed a health care agent. [Include name and address. If unknown, so state. ]* Has Has not executed a power of attorney for health care decisions. [Include name and address of person appointed to act. If unknown, so state.] Does Does not own real property. C.G.S. § 45a-658. [Include address, if applicable.] PETITION FOR VOLUNTARY REPRESENTATION BY CONSERVATOR PC-301 American LegalNet, Inc. www.FormsWorkFlow.com PETITION FOR VOLUNTARY REPRESENTATION BY CONSERVATOR PC-301 REV. 7/13 Page 2 STATE OF CONNECTICUT COURT OF PROBATE [Type or print in ink.] RECORDED: Has Is Is Does Has not received public assistance or institutional care from the State of Connecticut. Conn. Gen. Statutes Chapter 302. Is not a veteran or beneficiary receiving payment under any account from the Veterans' Administration. C.G.S. § 45a-593. Is not receiving aid or care from the Veterans' Home and Hospital, Rocky Hill, CT C.G.S. § 45a-649. Does not have a federal fiduciary. [Include name and address of person appointed to act. If unknown, so state.] Is Is not presently under conservatorship. *Please provide copies of these documents, if available. THE PETITIONER FURTHER REPRESENTS that the spouse and closest relatives, if any, of said petitioner are as written above. WHEREFORE, THE PETITIONER REQUESTS that this court appoint the proposed conservator named below or some other suitable person as: Conservator of the estate of the petitioner to carry out the following duties and authorities: Conservator of the person of the petitioner to carry out the following duties and authorities: AND THAT probate bond of the conservator with suitable surety be fixed at $ _________________ the conservator be excused from furnishing probate bond. The representations contained herein are made under the penalties of false statement. Date: Petitioner .................................................................... [Type or print name.] PETITION FOR VOLUNTARY REPRESENTATION BY CONSERVATOR PC-301 American LegalNet, Inc. www.FormsWorkFlow.com PETITION FOR VOLUNTARY REPRESENTATION BY CONSERVATOR PC-301 REV. 7/13 Page 3 STATE OF CONNECTICUT COURT OF PROBATE [Type or print in ink.] RECORDED: PROPOSED CONSERVATOR If appointed, I will accept the position of trust. Signature ............................................................................. Name [Type or print ] Address: Signature ............................................................................. Telephone Number(s): Telephone Number(s): ATTORNEY FOR PETITIONER [Name, address, telephone number and Conn. Bar Juris No.] Signature of attorney for petitioner ________________________________ Attorney shall also file form PC-183, Appearance of Attorney. PETITION FOR VOLUNTARY REPRESENTATION BY CONSERVATOR PC-301 American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL INFORMATION SHEET FOR PC-301, Petition for Voluntary Representation by Conservator REV. 7/13 STATE OF CONNECTICUT COURT OF PROBATE [Type or print in ink.] DO NOT RECORD Court, of Probate ______________________________________________ District The social security number of the petitioner is required in connection with this proceeding. In the Matter of: ______________________________________________________ , petitioner. Social Security Number: _________________________________________ PETITION FOR VOLUNTARY REPRESENTATION BY CONSERVATOR PC-301 American LegalNet, Inc. www.FormsWorkFlow.com
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