CONNECTICUT PROBATE COURTSPetition/Guardianship of Person with Intellectual Disability PC-700 REV. 10/1 CONFIDENTIAL RECEIVED: Instructions: 1) Any adult person may use this form to petition for the appointment of a guardian of the person ofan adult with intellectual disability. 223Intellectual disability224 2) ) Type or print the form in ink. Use an additional sheet if more space is needed. Probate Court Name District NumberPersons to Whom Notice Should Be Given: Respondent; Respondent222s Spouse and Parents (if any, and provided the spouse or parents are not the petitioner); Respondent222s Children (if any); Respondent222s Siblings or their Representatives (if any and if In the Matter of Respondent222s Date of Birth Address (ame and address of institution, if applicable.) Petitioner (ame, address and telephone number.) Petitioner222s Relationship to ) Address (if Address (if ) r.) American LegalNet, Inc. www.FormsWorkFlow.com CONNECTICUT PROBATE COURTSPetition/Guardianship of Person with Intellectual Disability PC-700 REV. 10/1 THE PETITIONER REPRESENTS that: The respondent is is not able to attend a hearing at the court.There is is not a plenary guardian, limited guardian or conservator for the respondent in any jurisdiction. (If so, list status, location, court and date of decree in the space below.) The respondent has an IQ of 69 or less. The respondent, by reason of the severity of his or her intellectual disability, is able to do some, but not all, of the tasks necessary to meet essential requirements for his or her physical health or safety or to make some, but not all, informed decisions about matters related to his or her care. (LIMITED GUARDIANSHIP) The respondent, by reason of the severity of his or her intellectual disability, is totally unable to meet essential requirements for his or her physical health or safety and totally unable to make informed decisions about matters related to his or her care. (PLENARY GUARDIANSHIP) Please list the specific areas of protection and assistance required for the respondent by checking the appropriate boxes below. The probate court may give a guardian the power to assure and/or consent to the following: residence outside the natural family home; specifically designed educational, vocational, or behavioral programs; the release of clinical records and photographs; routine, elective and emergency medical and dental care; other specific limited services necessary to develop or regain to the maximum extent possible the 's capacity to meet essential requirements. A plenary guardian will be given all of the above powers; a limited guardian will be given only those powers deemed necessary by the court. C.G.S. section 45a-677. Plenary and limited guardians also have a duty to assure the care and comfort of the within the scope of their appointment and within the limitations of the resources available to the , either through his or her own estate or by reason of public or private assistance. WHEREFORE THE PETITIONER REQUESTS that the court appoint a limited plenary guardian(s) of the person for the respondent. The petitioner also requests that the court appoint a standby limited plenary guardian(s) of the person for the respondent to act in the event that the appointed guardian dies, becomes incapable or renounces his guardianship. C.G.S. section 45a-680. The representations made in this petition are made under the penalty of false statement. Signature of the Petitioner Date Petition/Guardianship of Person with Intellectual Disability PC-700 Page 2 of 3 CONFIDENTIAL American LegalNet, Inc. www.FormsWorkFlow.com CONNECTICUT PROBATE COURTSPetition/Guardianship of Person with Intellectual Disability PC-700 REV. 10/1 IF APPOINTED, I WILL ACCEPT THE POSITION OF TRUST AS DETERMINED BY THE COURT. Proposed LIMITED PLENARY Guardian Signature Type or Print Name Address Telephone Number Proposed Standby LIMITED PLENARY Guardian Signature Type or Print Name Address Telephone Number Proposed LIMITED PLENARY Guardian Signature Type or Print Name Address Telephone Number Proposed Standby LIMITED PLENARY Guardian Signature Type or Print Name Address Telephone Number Petition/Guardianship of Person with Intellectual Disability PC-700 Page 3 of 3 CONFIDENTIAL American LegalNet, Inc. www.FormsWorkFlow.com