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Petition For Appointment-Confirmation Of Standby Guardian (SCPA 1757) CSMD-1 - New York

Petition For Appointment-Confirmation Of Standby Guardian (SCPA 1757) Form. This is a New York form and can be used in Guardianship Surrogates Court Statewide .
 Fillable pdf Last Modified 12/4/2006
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SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF ________________________ ----------------------------------------------------------------------------X In the Matter of the Application of ______________________________________ for Appointm ent/Confirm ation as Standby Guardian of Filing Fee Paid $ ________ ________ Certs $ ________ ________ Certs $ ________ $________ Bond, Fee $________ Receipt No: ________ No: ________ PETITION FOR APPOINTMENT/CONFIRM ATION OF STANDBY GUARDIAN [SCPA 1757] OF [ ] PERSON [ ] PROPERTY [ ] PERSON AND PROPERTY [ ] LIM ITED GUARDIAN OF THE PROPERTY File No. ________________ Pursuant to SCPA Article 17-A ----------------------------------------------------------------------------X TO THE SURROGATE'S COURT OF THE COUNTY OF____________________ It is respectfully alleged that: 1. The nam e, date of birth, perm anent address and telephone num ber of the petitioning [ ] guardian [ ] standby guardian [ ] alternate standby guardian [ ] second alternate standby guardian [ ] third alternate standby guardian(s) to the [ ] intellectually disabled [ ] developm entally disabled person (hereafter known as Respondent) is: Name: ___________________________________________________ Telephone Num ber: ___________________________ Perm anent Address or Corporate Office: _________________________________________________________________ (Street and Number) __________________________________________________________________________________________________ (City, Village, Town) (State) (If different from permanent address) (Zip Code) Mailing Address: ________________________________________________________________________________ Date of Birth: ____________________________ Interest/Relationship to Respondent: ______________________ 2(a). The nam e, perm anent address, date of birth and m arital status of the Respondent of this proceeding is as follows: Nam e: ____________________________________________________________________________________________ Perm anent Address: ________________________________________________________________________________ (Street and Number) __________________________________________________________________________________________________ (City, Village, Town) (State) (If different from permanent address) (Zip Code) Mailing Address: ________________________________________________________________________________ Date of Birth: _____________________________ Marital Status: ________________________________________ [Attach certified copy of birth certificate if not already filed with the court.] 2(b). [ ] The Respondent is not adm itted to a group hom e or facility as defined in Section 1.03 and/or Article 15 of the Mental Hygiene Law. [ ] The Respondent has been adm itted to a group hom e or facility as defined in Section 1.03 and/or Article 15 of the Mental Hygiene Law. Nam e of group hom e or facility: ________________________________________________________________________ Address of group hom e or facility: _______________________________________________________________________ Nam e of Director of group hom e or facility: __________________________________________________________________ Address of Director of group hom e or facility: ______________________________________________________________ Nam e of the Director of the Mental Hygiene Legal Service: ___________________________________________________ Address of the Director of the Mental Hygiene Legal Service: _________________________________________________ CSMD-1(8/2016) -1American LegalNet, Inc. www.FormsWorkFlow.com 3. The Petitioner was appointed [ ] guardian [ ] standby guardian [ ] alternate standby guardian [ ] second alternate standby guardian [ ] third alternate standby guardian in the above-titled m atter by decree on _________________, _____ and letters issued appointing _______________________________as guardian of the above-nam ed Respondent. W ithin said decree the Petitioner was appointed as [ ] standby guardian [ ] alternate standby guardian [ ] second alternate standby guardian [ ] third alternate standby guardian(s) subject to confirm ation. The guardian(s) is/are no longer able to act due to the following: [ [ [ [ ] ] ] ] death [attach a certified copy of the death certificate(s)] incapacity [attach proof of incapacity] adjudication of incom petency [attach proof] renunciation [attach proof of renunciation] 4. [Please note: Paragraph 5 to be completed only if new or different standby guardian(s) is/are to be designated in this proceeding.] 5. The nam es, perm anent addresses, dates of birth and relationship of the guardian(s) is/are: (a) Nam e of the Standby Guardian: _________________________________________________________________ Perm anent Address: _____________________________________________________________________________ (Street and Number) ______________________________________________________________________________________________ (City, Village, Town) (State) (Zip Code) Date of Birth: ___________________ Interest/Relationship to Respondent: __________________________________ Education: _______________________________ Qualifications: __________________________________________ to be appointed Standby Guardian of the [ [ [ [ ] ] ] ] person property person and property lim ited guardian of the property (b) Nam e of the Alternate Standby Guardian: ______________________________________________________ Perm anent Address: _____________________________________________________________________________ (Street and Number) ______________________________________________________________________________________________ (City, Village, Town) (State) (Zip Code) Date of Birth: ___________________ Interest/Relationship to Respondent: __________________________________ Education: _______________________________ Qualifications: __________________________________________ to be appointed Alternate Standby Guardian of the [ [ [ [ ] ] ] ] person property person and property lim ited guardian of the property (c) Name of the Second Alternate Standby Guardian: ____________________________________________________ Perm anent Address: _____________________________________________________________________________ (Street and Number) ______________________________________________________________________________________________ (City, Village, Town) (State) (Zip Code) Date of Birth: ___________________ Interest/Relationship to Respondent: __________________________________ Education: __
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