Petition/Appointment of Temporary Conservator PC - 302 REV. 4 /19 CONNECTICUT PROBATE COURTS Instructions: 1) Any adult person may use this form to petition for the appointment of a temporary conservator of another adult person in an emergency. The petitioner must allege that the respondent is incapable of managing his or her finances (for an appointment of a conservator of the estate) and/or incapable of caring for him or herself (for an appointment of a conservator of the person). The petitioner must also allege that immediate and irreparable harm to the respondent will result if a temporary conservator is not appointed. 2)The petition must be filed in the probate district in which the respondent resides, is domiciled or islocated at the time the petition is filed. A report by a physician who has examined the respondent not more than 3 days before the filing of the petition must accompany the petition, unless the respondent has refused to be examined. 3)The petitioner may request that the court issue a decree without notice and a hearing (ex parte) if thepetitioner believes that the delay resulting from giving notice will cause immediate and irreparable harm. If the court appoints a temporary conservator ex parte, the court must conduct a hearing to confirm or revoke the ex parte appointment. 4)If the petitioner is seeking the appointment of a conservator who would have the authority toconsent to the administration of involuntary medication for the treatment of the respondent222s psychiatric illness, the petitioner should also submit PC-309, Petition/Authority to Consent to Psychiatric Medication Treatment of Patient with Psychiatric Disabilities. 5)Any appointment of a temporary conservator expires 30 days after the date of appointment, unlessthe following documents have been filed in court prior to the expiration of the 30-day period: (a) Petition/Involuntary Appointment of Conservator, PC-300 and (b) a written request to extend the appointment of the temporary conservator. 6)For more information, see C.G.S. section 45a-654.7)Type or print in ink. Use an additional sheet, or PC-180, if more space is needed. Probate Court Name District Number In the Matter of Respondent222s Date of Birth Spouse Petitioner Petitioner222s Relationship to Respondent Respondent222s Residence Address Respondent222s Domicile Address American LegalNet, Inc. www.FormsWorkFlow.com Petition/Appointment of Temporary Conservator PC - 302 REV. 4 /19 CONNECTICUT PROBATE COURTS Other Persons to Whom Notice Should be Given: Spouse re spondent222s c hildren respondent222s parentsrespondent222s brothers and sisters or their representativesrespondent222s next of kin interested parties The petitioner represents (check all that apply) : American LegalNet, Inc. www.FormsWorkFlow.com Petition/Appointment of Temporary Conservator PC - 302 REV. 4 /19 CONNECTICUT PROBATE COURTS American LegalNet, Inc. www.FormsWorkFlow.com Petition/Appointment of Temporary Conservator PC - 302 REV. 4 /19 CONNECTICUT PROBATE COURTS A - Temporary Conservator of the Estate B - Temporary Conservator of the Person American LegalNet, Inc. www.FormsWorkFlow.com Petition/Appointment of Temporary Conservator PC - 302 REV. 4 /19 CONNECTICUT PROBATE COURTS WHEREFORE the petitioner requests The representations made in this petition are made under penalty of false statement. PROPOSED TEMPORARY CONSERVATOR If appointed, I will accept the position of trust: American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL INFORMATION/ Petition/Appointment of Temporary Conservator PC - 302CI R EV. 4 /19 CONNECTICUT PROBATE COURTSFOR COURT USE ONLY Probate Court Name District Number In the Matter of American LegalNet, Inc. www.FormsWorkFlow.com