PetitionProvisional Order Accepting Transfer of Conservatorship from Other State PC-305 REV. /19 CONNECTICUT PROBATE COURTS PetitionProvisional Order Accepting Transfer of Conservatorship from Other State PC - 305 Page 1 of 2 RECEIVED: Instructions: 1) A conservator or guardian of an adult appointed by a court of another state in an involuntary proceeding may file this petition to request a provisional order of a Connecticut Probate Court to accept the transfer of the conservatorship from the other state under the Connecticut Uniform Adult Protective Proceedings Jurisdiction Act. The court will not issue a final order accepting the transfer unless the court receives a final order by the transferring court under provisions similar to those in C.G.S. section 45a-667q. 2)Attach a certified copy of the original appointment of petitioner as conservator or guardian of an adultand a certified copy of the other state222s provisional order of transfer to the State of Connecticut. 3)For more information, see C.G.S. section 45a-667 et seq.4)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 Hereinafter referred to as the conserved person Conserved Person222s Present Address Conserved Person222s Intended Address in Connecticut Petitioner (Name, address and telephone number) Position of Trust in Appointing State Other Conservator/Guardian, if any (Name, address and telephone number) Position of Trust in Appointing State Court from Which Transfer of Conservatorship is Requested (Name, address and telephone number) Persons to Whom Notice Should be Given: Spouse (if not the petitioner), the conserved person222s children, and if none, the conserved person222s parents, and, if none, the conserved person222s brothers and sisters or their representatives, and if none, the conserved person222s next of kin and other interested parties (List names, addresses and relationships to the conserved person. 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. Continue on next page if more space is needed.) American LegalNet, Inc. www.FormsWorkFlow.com PetitionProvisional Order Accepting Transfer of Conservatorship from Other State PC-305 REV. /19 CONNECTICUT PROBATE COURTS In the Matter of PetitionProvisional Order Accepting Transfer of Conservatorship from Other State PC - 305 Page 2 of 2 Persons to Whom Notice Should be Given (Continued): Other Persons Entitled to Notice in the State from which Transfer of the Conservatorship is Requested (List names, addresses and relationships to conserved person.) The petitioner represents that the State of appointed the petitioner as: conservator/guardian of the person conservator/guardian of the estate WHEREFORE the petitioner requests that this court issue a provisional order accepting transfer of the conservatorship of the person the conservatorship of the estate. The representations made in this petition are made under penalty of false statement. Signature of Petitioner Type or Print Name Date American LegalNet, Inc. www.FormsWorkFlow.com