Petition for Appointment of Conservator of the Estate for Non-Domiciliary with Real or Tangible Personal Property in the State PC-3011 NEW 7/16 CONNECTICUT PROBATE COURTS RECORDED: RECEIVED: Instructions: 1) If a conservator of the estate, or a fiduciary with equivalent authority, has been appointed in another state for an incapable person who is not domiciled in Connecticut, a family member of the conserved person or a conservator or guardian of the estate or person of the incapable person may use this form to petition for appointment of a conservator of the estate with authority over Connecticut real or tangible personal property owned by the conserved person. 2) The petition, together with a certified copy of the appointment of a conservator of the estate in the state of the incapable person's domicile, must be filed in the court for the probate district in which the real or tangible personal property, in whole or in part, is situated. 3) For more information, see C.G.S. section 45a-659. 4) Type or print the form in ink. District Number Respondent's date of birth Respondent's town and state of domicile (if different from address listed) Probate Court Name In the Estate of (List name and address.) Hereinafter referred to as the respondent. Petitioner (List name and address.) Petitioner's relationship to respondent If petitioner is a fiduciary, list title and date of court appointment. Name(s) and address(es) of other persons to whom notice should be given: (Spouse, other close relatives and interested parties. Identify relationships.) THE PETITIONER REPRESENTS THAT: 1) The respondent is domiciled in the town and state listed above. 2) The respondent has been adjudicated incapable by a court of the state of ________________________ and ____________________________ has been appointed conservator of the estate, or a fiduciary with equivalent authority, of the respondent by decree dated_________________________________, a copy of which is attached. 3) The respondent owns real property and/or tangible personal property situated in this probate district. American LegalNet, Inc. www.FormsWorkFlow.com Petition for Appointment of Conservator of the Estate for Nondomiciliary PC-3011 Page 1 of 2 Petition for Appointment of Conservator of the Estate for Non-Domiciliary with Real or Tangible Personal Property in the State PC-3011 NEW 7/16 CONNECTICUT PROBATE COURTS RECORDED: WHEREFORE THE PETITIONER REQUESTS THAT: The court appoint _______________________________________________ conservator of the estate of the respondent pursuant to the provisions of C.G.S. section 45a-659 (b). The representations made in this petition are made under the penalty of false statement. Signature of Petitioner Type or Print Name Date Proposed Conservator of Estate If appointed, conservator of the estate, I will accept the position of trust. Signature of Proposed Conservator Type or Print Name Date Address Telephone Number American LegalNet, Inc. www.FormsWorkFlow.com Petition for Appointment of Conservator of the Estate for Nondomiciliary PC-3011 Page 2 of 2 Confidential Information/Petition for Appointment of Conservator of the Estate for Non-Domiciliary with Real or Tangible Personal Property in the State PC-3011C NEW 7/16 CONNECTICUT PROBATE COURTS DO NOT RECORD - FOR COURT USE ONLY RECEIVED: Probate Court Name In the Matter of District Number The social security number of the following person is required in connection with this proceeding. Name of the Respondent:______________________________________ Social Security Number:_______________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Confidential Information/Appointment of Conservator of the Estate for Nondomiciliary PC-3011C