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Petition Guardianship Of Person With Intellectual Disability PC-700 - Connecticut

Petition Guardianship Of Person With Intellectual Disability Form. This is a Connecticut form and can be used in Probate Statewide .
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Petition/Guardianship of Person With Intellectual Disability PC-700 Rev. 1/14 RECEIVED: CONNECTICUT PROBATE COURTS RECORDED - CONFIDENTIAL: Instructions: 1) Any adult person may use this form to petition for the appointment of a guardian of the person of an adult with intellectual disability. "Intellectual disability" is defined by statute as "a significant limitation in intellectual functioning and deficits in adaptive behavior that originated during the developmental period before eighteen years of age." A "significant limitation in intellectual functioning" is defined as an intelligence quotient ("IQ") more than two standard deviations below the mean, as measured by standard tests of general intellectual functioning. This means that the person's IQ must be 69 or less. 2) The person for whom the appointment of a guardianship of the person is being requested is referred to as the respondent. A person with intellectual disability for whom a guardian is appointed is referred to in the statutes as a ward. 3) Type or print the form in ink. Use an additional sheet if more space is needed. District Number Respondent's Date of Birth Probate Court Name In the Matter of Respondent's Present Address (List name and address of institution, if applicable.) Respondent's Town of Domicile Petitioner (List name, address and telephone number.) Petitioner's Relationship to Respondent Persons to Whom Notice Should Be Given: Respondent; Respondent's Spouse and Parents (if any, and provided the spouse or parents are not the petitioner); Respondent's Children (if any); Respondent's Siblings or their Representatives (if any and if respondent has no living parents); Person in Charge of the Institution where the Respondent Currently Resides (if applicable); Attorney for the Respondent (if any); and any Other Persons Having an Interest in the Respondent. (List names, addresses and relationships to respondent. If attorney for respondent, list juris number.) C.G.S. section 45a-671. Petition/Guardianship of Person with Intellectual Disability PC-700 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Petition/Guardianship of Person With Intellectual Disability PC-700 Rev. 1/14 THE PETITIONER REPRESENTS that: The respondent There is is CONNECTICUT PROBATE COURTS RECORDED - CONFIDENTIAL: is not able to attend a hearing at the court. is not a plenary guardian, limited guardian or conservator for the respondent in any jurisdiction. (If so, list status, location, court and date of decree in the space below.) The respondent, by reason of the severity of his or her intellectual disability, is able to do some, but not all, of the tasks necessary to meet essential requirements for his or her physical health or safety or to make some, but not all, informed decisions about matters related to his or her care. (LIMITED GUARDIANSHIP) The respondent, by reason of the severity of his or her intellectual disability, is totally unable to meet essential requirements for his or her physical health or safety and totally unable to make informed decisions about matters related to his or her care. (PLENARY GUARDIANSHIP) Please list the specific areas of protection and assistance required for the respondent by checking the appropriate boxes below. The probate court may give a guardian the power to assure and/or consent to the following: residence outside the natural family home; specifically designed educational, vocational, or behavioral programs; the release of clinical records and photographs; routine, elective and emergency medical and dental care; other specific limited services necessary to develop or regain to the maximum extent possible the ward's capacity to meet essential requirements. A plenary guardian will be given all of the above powers; a limited guardian will be given only those powers deemed necessary by the court. C.G.S. section 45a-677. Plenary and limited guardians also have a duty to assure the care and comfort of the ward within the scope of their appointment and within the limitations of the resources available to the ward, either through his or her own estate or by reason of public or private assistance. WHEREFORE THE PETITIONER REQUESTS that the court appoint a person for the respondent. limited plenary guardian(s) of the The petitioner also requests that the court appoint a standby limited plenary guardian(s) of the person for the respondent to act in the event that the appointed guardian dies, becomes incapable or renounces his guardianship. C.G.S. section 45a-680. The representations contained herein are made under the penalties of false statement. Signature of the Petitioner___________________________ Date__________________________ Petition/Guardianship of Person with Intellectual Disability PC-700 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Petition/Guardianship of Person With Intellectual Disability PC-700 Rev. 1/14 CONNECTICUT PROBATE COURTS RECORDED - CONFIDENTIAL: IF APPOINTED, I WILL ACCEPT THE POSITION OF TRUST AS DETERMINED BY THE COURT. Proposed LIMITED PLENARY Guardian Signature_____________________________________ Type or Print Name_____________________________ Address______________________________________ ____________________________________________ Telephone Number_____________________________ Proposed Standby LIMITED PLENARY Guardian Signature_______________________________________ Type or Print Name_______________________________ Address________________________________________ ______________________________________________ Telephone Number________________________________ Proposed LIMITED PLENARY Guardian Signature____________________________________ Type or Print Name____________________________ Address_____________________________________ ____________________________________________ Telephone Number____________________________ Proposed Standby LIMITED PLENARY Guardian Signature________________________________________ Type or Print Name________________________________ Address_________________________________________ _______________________________________________ Telephone Number____________________________ Petition/Guardianship of Person with Intellectual Disability PC-700 Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com
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