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Petition For Limited Guardianship Or Guardianship PC-2.3 - Rhode Island
| Petition For Limited Guardianship Or Guardianship Form. This is a Rhode Island form and can be used in Guardian Conservator Custodian And Receiver Probate Court Statewide . |
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PC-2.3 (11/02, formerly SW-76) Petition for Limited Guardianship or Guardianship Date filed: _____________________ Court use only STATE OF RHODE ISLAND County of ___________________________________ PROBATE COURT OF THE Estate of ____________________________________ _________________________________________________ Alias _______________________________________ Alias _______________________________________ No. ____________________ ____________________ Date PETITION FOR LIMITED GUA RDIANSHIP OR GUARDIANSHIP Petitioner ________________________________________________________________________________________ Name of Petitioner hereby petitions the Probate Court of the city/town of _____________________________________________________ Probate Court City/Town to appoint a limited guardian/guardian for ______________________________________________________________ Name of Respondent who currently resides at ____________________________________________________________________________ No. Street City/Town State Zip and whose date of birth is _____________________________________________. Date of birth Based upon an assessment conducted by _______________________________________________________________ Name of Assessor on ________________________________________________________ which assessment reflects the current level of Date of Assessment functioning of _____________________________________________________________, it has been determined that Name of Respondent _____________________________________________________, lacks decision-making ability in one or more of the Name of Respondent following areas as indicated: [ ] health care __________________________________________________________________ Describe specific assistance needed __________________________________________________________________ [ ] financial matters __________________________________________________________________ Describe specific assistance needed __________________________________________________________________ [ ] residence __________________________________________________________________ Describe specific assistance needed __________________________________________________________________ [ ] association __________________________________________________________________ Describe specific assistance needed __________________________________________________________________ [ ] other __________________________________________________________________ Describe specific assistance needed __________________________________________________________________ <<<<<<<<<********>>>>>>>>>>>>> 2PC-2.3 (11/02) Page 2 Indicate which of the following less restrictive alternatives to guardianship have been explored and deemed inappropriate as indicated: [ ] Durable Power of Attorney for Health Care [ ] Representative Payee [ ] Living Will [ ] Money Management [ ] Power of Attorney [ ] Single Court Transactions [ ] Durable Power of Attorney [ [ ] Trusts [ ] Housing Options [ ] Joint Property Arrangements [ ] Other Please describe the basis for the determination that the alternative will not meet the needs of the respondent for each alternative explored and deemed inappropriate: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ The following individual/agency is willing to serve as guardian: _______________________________________________________________________________________________ Upon information and belief the above individual/agency has: [ ] No conflict of interest that would interfere with guardianship duties. [ ] No criminal background that would interfere with guardianship status. [ ] The capacity to manage financial resources involved. [ ] The ability to meet requirements of law and unique needs of individual. [ ] Demonstrated willingness to undergo training. <<<<<<<<<********>>>>>>>>>>>>> 3PC-2.3 (11/02) Page 3 The respondent has the following heirs at law: NAME: R ESIDENCE: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Attach form PC9.1, Waiver, if applicable. The undersigned petitioner makes affidavit and says that the above facts are true as to the best of his/her knowledge f. and belie __________________________________________ __________________________________________ Signature of petitioner Date __________________________________________ __________________________________________ Petitioner Street No. Address City/Town State Zip Phone Number _______________________________________ Sc. Subscribed and sworn to before me as to the truth of all of the above facts by the petitioner. __________________________________________ __________________________________________ Notary public (please print nam e) Notary public signatur e DECREE This cause having come on to be heard after being duly advertised according to law, it is hereby ordered, adjudged and decreed that _____________________________________________ be appointed guardian of the person and estate of ____________________________________________, bond to be filed in the amount of $______________________. Entered as an order and decree of the court on: _______________________________________________ _______________________________________________ Date Probate Judge
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