Kentucky > Statewide > Hospitalization-Disability
Petition For Relief Modification Or Termination AOC-795 - Kentucky
| Petition For Relief Modification Or Termination Form. This is a Kentucky form and can be used in Hospitalization-Disability Statewide . |
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AOC-795 Rev. 7-11 Page 1 of 2 Doc. Code: PRMT COM M O NW E A LT H O F K E lex et justitia Case No. ____________________ DISTRICT Court _______________________ NT U C KY CO Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 387.620 COMMONWEALTH OF KENTUCKY VS. U RT OF JUS TI County ______________________ PETITION FOR RELIEF, MODIFICATION OR TERMINATION PETITIONER _____________________________________________ C E RESPONDENT ************ Comes the Petitioner and requests the Court to q terminate q modify as follows: q The order of q partial disability q disability entered on ____________________________________ be q terminated q modified as follows: _____________________________________________________ ____________________________________________________________________________________ q q 1. 2. To remove the present fiduciary and replace with ____________________________________________. To renew the appointment of the present fiduciary for a period of ________________________________. In support of this request, Petitioner states: The Respondent's address: ____________________________________________________________________ In custody of: _______________________________________________________________________________ Respondent's present fiduciary: _________________________________________________________________ Address: ___________________________________________________________________________________ Appointed on: _______________________________________________________________________________ As: q Limited Guardian q Guardian q Limited Conservator q Conservator 3. The Respondent's q Durable Power of Attorney q Health Care Surrogate is: _____________________________________________ Address _____________________________________________ _____________________________________________ _____________________________________________ Name 4. Respondent's next of kin are: Name Address ______________________________ ______________________________ ______________________________ Relationship _____________________________ _____________________________ _____________________________ ______________________________ ______________________________ ______________________________ 5. The facts and reasons supporting this request: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com AOC-795 Rev. 7-11 Page 2 of 2 Doc. Code: PRMT WHEREFORE, the Petitioner requests that this court conduct a hearing within thirty (30) days of the filing of this petition. If the foregoing petition is for a renewal of the appointment of a limited guardian or conservator, it shall be accompanied by verified affidavits of a physician, a psychologist, or a social worker in support of same pursuant to KRS 387.610. _____________________________________________ Petitioner _____________________________________________ Address _____________________________________________ Relationship to Respondent SUBSCRIBED and SWORN to before me this ___________ day of _____________________________, ________. _____________________________________________ Name/Title _____________________________________________ County, Kentucky To be completed if Petitioner is represented by counsel: _____________________________________________ Signature of Attorney _____________________________________________ Address of Attorney _____________________________________________ Telephone Number An attested copy of this Petition was mailed this date to the Respondent, the attorney of record, the county attorney and all persons named in the Petition. _________________________________________ Date _____________________________________________ Signature Print Reset Form American LegalNet, Inc. www.FormsWorkFlow.com
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