Superior Court of the District of Columbia II-B PROBATE DIVISION IN RE: Intervention Proceeding No. An Adult PETITION FOR TERMINATION OF APPOINTMENT OF Guardian Conservator 1. (a) Name of Petitioner (b) (Address of Petitioner) (c) (Petitioner's Relationship to Subject of Proceeding) 2. (a) (Name of Subject of Proceeding) (b) (Age of Subject of Proceeding) (c) (Address and Residence of Subject of Proceeding) (d) (Name and address of Guardian) (e) (Name and address of Conservator) 3. The subject of the proceeding is no longer incapacitated because said individual is an adult whose ability to receive and evaluate information effectively or to communicate decisions is not impaired to such an extent FormP D- 1884A/Sep. 89 2002 © American LegalNet, Inc. that he or she lacks the capacity, without court-ordered assistance or the appointment of a guardian or conservator, to take actions necessary to: (Select appropriate box(es)) obtain, administer, and dispose of real and persona property, intangible property, business property, benefits, and income and/or provide health care, food, shelter, clothing, personal hygiene, and other care without which serious physical injury or illness is more likely than not to occur and/or acquire and maintain those life skills that enable him or her to cope more effectively with the demands of his or her own person and of his or her own environment and to raise the level of his or her physical, intellectual, social, emotional, and economic efficiency or meet all or some essential requirements for his or her therapeutic needs. (b) The specific reasons why the subject of this proceeding is no longer incapacitated are: (c) The alleged incapacity of the subject of this proceeding did did not arise out of mental retardation. (d) A comprehensive evaluation or habilitation plan does not exist. 4. (a) does The name and address of the personal examiner (e.g. attending physician) of the subject of this proceeding is (b) (c) An existing examiner's report is attached hereto. Petitioner seeks appointment of said personal examiner as examiner and (1) (2) Petitioner has discussed such appointment with said personal examiner and advised the personal examiner of the duties of the examiner, and the right of the subject to cross-examine the examiner in court. The subject's personal examiner is willing to serve as examiner. Forte PD-18S4B/Sep. 89 2002 © American LegalNet, Inc. (d) Petitioner does not seek appointment of said personal examiner as examiner and requests the Court to appoint another person as examiner. (e) Petitioner waives appointment of an examiner. 5. (a) The name and address of a personal visitor [e.g. social worked who is familiar with the case of the subject this proceeding is (b) Petitioner seeks appointment of said person as visitor, and (1) Petitioner has discussed such appointment with the nominated visitor and advised the nominee of the duties of the visitor, and the right of the subject to cross-examine the visitor in court. (2) The subject's personal visitor is willing to serve as visitor. (c) Petitioner does not seek appointment of said person as visitor and requests the Court to appoint another person as visitor. (d) Petitioner waives appointment of a visitor. 6. Listed below are the names and addresses of the parties to whom notice will be sent pursuant to SCR-PD 325: Name of Subject of Proceeding Spouse and adult children Any counsel to the subject known to Petitioner Persons nominated in subject's durable power of attorney to be Guardian and Conservator 7. (a) Petitioner requests the Court to appoint a Guardian Ad Litem for the subject of this proceeding for the following purpose(s): To assist the subject to determine his or her interests in regard to this proceeding. Form PD-1884C/Sep. 89 2002 © American LegalNet, Inc. To determine the interests of the subject in regard to this proceeding because the subject is unconscious or otherwise wholly incapable of determining his or her interest in this proceeding even with assistance. (b) 8. Appointment of a Guardian Ad Litem is not requested. (a) Termination of the appointment of the guardian is sought because a guardian is not necessary as a means of providing continuing care and supervision of the subject of this proceeding and/or (b) A protective order should be made or (c) The appointment of the conservator should be terminated because: (Select appropriate box(es)) the subject has no property that will be wasted or dissipated unless property management is provided, and/or money is not needed for the support, care and welfare of the said individual, and/or money is needed for those entitled to said individual's support and but protection is not necessary or desirable to obtain and provide money. 9. 10. If entry of a protective order is sought, describe generally the subject's property with an estimate of the value of that property including any compensation, insurance, pension, or allowance to which the subject is entitled. The Petitioner seeks the following relief: Entry of a protective order as follows: Termination of appointment of the conservator. guardian and/or Form PD-I884D/Sep. 89 2002 © American LegalNet, Inc. VERIFICATION , being first duly sworn, on oath, I [OR: I , affirm] depose and say that I have read the foregoing pleadings by me subscribed and that the facts therein stated are true to the best of my knowledge, information and belief. day o f Subscribed and sworn to before me this Notary Public CERTIFICATION OF SERVICE I hereby certify that on the day of a copy of the foregoing was served by first class mail, postage prepaid, upon the following parties to the above captioned case and persons granted permission to participate pursuant to SCR-PD 303 and persons who requested notice pursuant to SCR-PD 304. Signature Name, Address, Telephone Number and Unified Bar Number of Counsel for Petitioner Form PD-1884E/Sep. 89 2002 © American LegalNet, Inc.