Petition/Determination of Competency to Vote Re: Person with Intellectual Disability PC-705 REV. 10/16 RECEIVED: CONNECTICUT PROBATE COURTS RECORDED(CONFIDENTIAL: Instructions: 1) A guardian of the person may use this form to petition the court for a determination of the competency to vote of an adult with intellectual disability pursuant to C.G.S. section 45a-703. 2) Type or print the form in ink. District Number Probate Court Name In the Matter of (List name and present address of person with intellectual disability.) Hereinafter referred to as the protected person. Guardian/Petitioner (List name and address.) Other Persons to Whom Notice Should Be Given: Protected person's spouse, children, parents and, if no living parents, siblings or representatives; protected person's attorney; person in charge of the institution or facility where the protected person currently resides; and other persons entitled to notice under the Probate Court Rules of Procedure, section 8.2. (List names and addresses. Include relationship to protected person.) I am the guardian of the person of the adult with intellectual disability. I request that the court determine whether the protected person is competent to vote in a primary, referendum or election. The representations made in this petition are made under the penalty of false statement. Signature of Guardian Type or print name Date Petition/Determination of Competency to Vote Re: Person with Intellectual Disability American LegalNet, Inc. www.FormsWorkFlow.com PC-705