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Conservators Report PC-371 - Connecticut
| Conservators Report Form. This is a Connecticut form and can be used in Probate Statewide . |
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CONSERVATOR'S REPORT PC-371 REV. 10/04 STATE OF CONNECTICUT RECORDED(CONFIDENTIAL VOLUME): COURT OF PROBATE [Type or print in black ink.] [Use back of form or additional sheets if more space is required.] TO: COURT OF PROBATE, DISTRICT OF DISTRICT NO. IN THE MATTER OF [Name, address, zip code, and date of birth] PRESENT ADDRESS OF WARD [If institutionalized, give name and address of institution.] HEREINAFTER REFERRED TO AS THE "WARD" PRESENT TREATING PHYSICIAN [Name, address, and zip code] CONSERVATOR OF THE PERSON [Name, address, zip code, and telephone number] This conservator's report is being filed for the following reason: [C.G.S. §§45a-654(f), 45a-656, 45a-660(c)] Annual Report Court-ordered Report Significant change in the ward's capacity to meet the essential requirements for physical health or safety Reporting period covered by this report --- FROM: Conservator has resigned or has been removed. Application for restoration has been filed. Temporary conservatorship has terminated. TO: Indicate number of visits made during reporting period: List significant changes in the capacity of the ward to meet the essential requirements for physical health or safety. If applicable, list any significant actions you have taken regarding the ward during this reporting period. If applicable, list any significant problems relating to the conservatorship that have arisen during this reporting period. Describe general physical and mental condition of the ward. [List any other factors.] This section is to be completed for three-year reviews of conservatorship pursuant to C.G.S. §45a-660. continued modified terminated. In my opinion, the conservatorship should be Give reasons for your answer. ....................................................................................... Conservator: Dated at: CONSERVATOR'S REPORT PC-371 ,Connecticut, on [Month, Day, Year] American LegalNet, Inc. www.USCourtForms.com
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