Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Verified Motion For Appointment Of Temporary Guardian For Adult Form. This is a Massachusetts form and can be use in Probate And Family Court Statewide.
Loading PDF...
Tags: Verified Motion For Appointment Of Temporary Guardian For Adult, MPC 320, Massachusetts Statewide, Probate And Family Court
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court
VERIFIED MOTION FOR APPOINTMENT OF Docket No.
TEMPORARY GUARDIAN FOR AN
INCAPACITATED PERSON PURSUANT TO
G.L. c.190B, ยง 5-308
Division
In the Interests of:
First Name
Middle Name
Last Name
Alleged Incapacitated Person/Respondent
on Petition filed
The court shall encourage the development of maximum self-reliance and independence of the Incapacitated
Person and make appointive and other orders only to the extent necessitated by the Incapacitated Person's
limitations or other conditions warranting the guardianship.
Now comes the moving party
First Name
M.I.
Last Name
who states as follows:
1. An emergency exists requiring the appointment of a Temporary Guardian as any delay in the appointment will cause
immediate and substantial harm to the health, safety or welfare of the Respondent, and no other person has authority to
act in the circumstances.
2. The nature of the circumstances requiring the appointment of a Temporary Guardian are:
3. The particular harm sought to be avoided is:
4. The actions which need to be taken by a Temporary Guardian to avoid the harm are:
5. Respondent:
Does (See Petition)
does not have a Health Care Agent in the Commonwealth or elsewhere or
A copy of the Health Care Proxy is
attached
already filed with the Court
Uncertain.
unavailable.
6. Respondent:
Does (See Petition)
does not have a Durable Power of Attorney/Agent in the Commonwealth or elsewhere or
Uncertain.
A copy of the Durable Power of Attorney is
The within Motion hereby is
attached
already filed with the Court
unavailable.
ALLOWED (see Order Appointing Temporary Guardian).
DENIED.
Date
JUSTICE OF THE PROBATE AND FAMILY COURT
MPC 320 (5/30/11)
American LegalNet, Inc.
www.FormsWorkFlow.com
page
1
of
2
WHEREFORE, PETITIONER REQUESTS THAT THIS HONORABLE COURT:
Appoint
The Petitioner(s) or
or
First Name
Last Name
M.I.
Some suitable person.
as Temporary Guardian(s) of the Respondent to serve
without sureties for the following reasons:
with
The moving party further seeks specific court authorization:
to admit Respondent to a nursing facility;
to treat Respondent with antipsychotic medication in accordance with a treatment plan;
for the following treatment or action for which a substituted judgment determination may
be required:
to revoke the Health Care Proxy of the Incapacitated Person;
to apply for health insurance benefits including MassHealth on behalf of the Respondent.
In addition, I request that the Court:
SIGNED UNDER THE PENALTIES OF PERJURY
I affirm or swear under oath that I have read the foregoing Motion and that the statements set forth therein are true
and correct to the best of my knowledge.
Date
Signature of Moving Party
Date
Signature of Attorney for Moving Party
(Print name)
(Address)
(City/Town)
(Apt, Unit, No. etc.)
(State)
(Zip)
Primary Phone #:
B.B.O. #
MPC 320 (5/30/11)
page
2
of
American LegalNet, Inc.
www.FormsWorkFlow.com
2
