I-A Superior Court of the District of Columbia PROBATE DIVISION IN RE: Intervention Proceeding _____________________________ An Adult No. _____________________ PETITION FOR PERMISSION TO PARTICIPATE In accordance with SCR-PD 303, I, ___________________________________, (Name of Petitioner) hereby seek permission to participate in this proceeding in the following manner: ___________________________________________________________________. I am not required to be notified of this proceeding by D.C. Code §21-2042(a) or § 21-2053(a). My relationship (if any) to the subject of the proceeding is as follows: ___________________________________________________________________. My participation in the proceeding will serve the best interest of the proceeding because: ____________________________________________________________ ___________________________________________________________________. Wherefore, I request that an order be entered permitting me to participate in this proceeding, and for such other relief as the nature of the case may require and the court may deem just and proper. VERIFICATION I _____________________________________, being first duly sworn, on oath, [OR: I_______________________________________ affirm] depose and say that I have read the following pleading by me subscribe and that the facts therein stated are true to the best of my knowledge, information and belief . _________________________________ (Signature of Petitioner Subscribed and sworn to before me this _______ day of _______________ 20____. ______________________________ Notary Public Form PD-1870A/Sep. 89 American LegalNet, Inc. www.FormsWorkflow.com _________________________________ ________________________________ (Signature of Attorney) (Signature of Requestor) _________________________________ ________________________________ (Typewritten Name of Attorney) ( Typewritten Name of Requestor) _________________________________ ________________________________ (Address) (Address) _________________________________ (Address) ________________________________ Telephone No. _____________________ Telephone No. ___________________ Bar No. (Address) _____________________ CERTIFICATE OF SERVICE I hereby certify that on the ___________ day of _____________, 20 ______, a copy of the foregoing _______________________________________ was served by first class mail, postage prepaid, upon the following parties to the above captioned case and persons granted permission to participate pursuant to SCR-PD 303 and persons who requested notice pursuant to SCR-PD 304. _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ ___________________________________ Signature Form PD-1870/Sep. 89 American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com