Petition /Involuntary Appointment of Conservator PC-300 REV. 4/19 CONNECTICUT PROBATE COURTS Petition /Involuntary Appointment of Conservator Page 1 of 6 RECEIVED: Instructions: 1) Any adult person may use this form to petition for the appointment of a conservator of an adult who is alleged to be incapable. A 223conservator of the person224 is appointed to supervise the personal affairs of a person whom the court finds to be unable to meet essential requirements for personal needs, even with appropriate assistance. These needs may include, but are not limited to, the need for food, clothing, shelter, health care and safety. A 223conservator of the estate224 is appointed to supervise the financial affairs of a person whom the court finds to be incapable of doing so to the extent that property will be wasted unless adequate property management is provided. This may include, but is not limited to, actions to obtain and manage assets, income and public assistance benefits. The petition may also request the appointment of a successor conservator 2)The person for whom the appointment of a conservatorship is being requested is referred to as therespondent.3)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. If the proposed fiduciary is not a Connecticut resident, attach acompleted Appointment of Probate Judge as Agent for Service by Non-Resident Fiduciary, PC-482. 4) If the petitioner is seeking the appointment of a conservator who would have the authority to consentto the administration of involuntary medication for the treatment of the respondent222s psychiatricillness, the petitioner should also submit P-309, Petition/Authority to Consent to PsychiatricMedication Treatment of Patient with Psychiatric Disabilities. 5)For more information, see C.G.S. section 45a-648 et seq. 6) Type or print ink. Use an additional sheet, or PC-180, if more space is needed. Probate Court Name District Number In the Matter of Hereinafter referred to as the respondent Respondent222s Date of Birth Spouse (Name, address and telephone number) Petitioner (Name, address and telephone number) Petitioner222s Relationship to Respondent Respondent222s Residence Address Respondent222s Domicile Address (If different) Respondent222s Present Address (If different) American LegalNet, Inc. www.FormsWorkFlow.com Petition/ Involuntary Appointment of Conservator PC-300 REV. 4/19 CONNECTICUT PROBATE COURTS In the Matter of Petition /Involuntary Appointment of Conservator Page 2 of 6 Other Persons to Whom Notice Should be Given: Spouse (if not the petitioner), the respondent222s children, and if none, the respondent222s parents, and, if none, the respondent222s brothers and sisters or their representatives, and if none, the respondent222s next of in and other interested parties (List names, addresses and relationships to respondent. C.G.S. section 45a-649. Indicate any person who is a minor, in the military service or under conservatorship or legal disability. Include the name, address and position of trust of the legal representative of any party The petitioner states that the following efforts have been made to identify or locate any person whose name and/or address is unknown. The petitioner represents that (check all that apply): The respondent has been physically present in Connecticut for at least six months before the filing of the petition, including any periods of temporary absence. If not, attach completed form PC-300A. A conservator or guardian has been appointed for the respondent in another state or Connecticut probate district. If so, indicate the appointing court: There is a proceeding pending for the appointment of a conservator or guardian in another state or Connecticut probate district. If so, indicate the court in which the proceeding is pending: The respondent has designated a conservator as provided by C.G.S. section 45a-645. If so, include name and address. If unknown, so state. If the respondent has designated a conservator, and the proposed conservator named herein is not the designated conservator, explain by separate document. American LegalNet, Inc. www.FormsWorkFlow.com Petition/ Involuntary Appointment of Conservator PC-300 REV. 4/19 CONNECTICUT PROBATE COURTS In the Matter of Petition /Involuntary Appointment of Conservator Page 3 of 6 ppoint a health care agent. ower of attorney for health care decisions. ower of attorney. Explain why these arrangements for the management of respondent222s financial or personal affairs are not adequate: List other means of management of the respondent222s fi nancial or personal affairs, not including the appointment of a conservator, that have been considered: Owns real property Has received public assistance or institutional care from the State of Connecticut. Is receiving aid or care from the Veteran222s Home and Hospital, Rocky Hill, CT. C.G.S. section 45a-649. Is a veteran or beneficiary receiving payment under an account from the Dept. of Veteran222s Affairs. C.G.S. section 45a-593. Has a federal fiduciary for Veteran222s Affairs benefits. name and address of person appointed to act. point health care representative. iving will. American LegalNet, Inc. www.FormsWorkFlow.com Petition/ Involuntary Appointment of Conservator PC-300 REV. 4/19 CONNECTICUT PROBATE COURTS In the Matter of Petition /Involuntary Appointment of Conservator Page 4 of 6 Is a patient in a hospital or institution. C.G.S. section 45a-649. Is in an institution for persons with psychiatric disabilities in this state. Is able to request or obtain an attorney. C.G.S. section 45a-649. Is able to pay for the services of an attorney. If not, submit Request/Order-Waiver of Fees, PC-184A. The petitioner further represents that: The mental, emotional and/or physical condition that prevents the respondent from performing the necessary and proper functions for his or her well - being i s as follows: (Describe briefl y.) If the petition is for the appointment of a CONSERVATOR OF THE ESTATE, complete Part A. If the petition is for the appointment of a CONSERVATOR OF THE PERSON, complete Part B. If the petition is for BOTH conservator of the estate and conservator of the person, complete both Part A and Part B. A - Conservator of the Estate The condition described above results in the respondent being unable to receive and evaluate information or make or communicate decisions to such an extent that the person is unable, even with appropriate assistance, to perform the following functions inherent in managing his or her financial affairs: AND (check all that apply) : he respondent has property rights that will be wasted or dissipated unless adequate property management is provided. unds are needed for the support, care or welfare of the respondent, and the respondent is unable to take the necessary steps to obtain or provide such funds. unds are needed for the support, care or welfare of those entitled to be supported by the respondent, and the respondent is unable to take the necessary steps to obtain or provide such funds. American LegalNet, Inc. www.FormsWorkFlow.com Petition/ Involuntary Appointment of Conservator PC-300 REV. 4/19 CONNECTICUT PROBATE COURTS In the Matter of Petition /Involuntary Appointment of Conservator Page 5 of 6 B - Conservator of the Person The condition described above results in the respondent being unable to receive and evaluate information or make or communicate decisions to such an extent that the person is unable, even with appropriate assistance, to meet the following essential requirements for personal needs: WHEREFORE the petitioner requests that this court appoint the proposed conservator named below or some other suitable person as conservator of the respondent. (If the Commissioner of Social Services is the proposed conservator of the estate and/or person, attach Affidavit/Appointment of Commissioner of Social Services as Conservator, PC-310. C.G.S. section 45a-651.) The petitioner also requests that the court appoint a successor conservator of the person the estate for the respondent to act in the event that the court accepts th