Defendant(s) : ...................................................... WHAT YOU NEED TO KNOW BEFORE THE PEOPLE OF THE STATE OF NEW YORK FILING »» Is a guardian needed for an individual who may be legally incapacitated? A PETITION TO APPOINT A GUARDIAN FOR AN TO INCAPACITATED ADULT »» What is a guardian? A guardian is a person appointed by a probate court GREETINGS: A guardian might not be necessary if someone else already has legal authority to make decisions for the person and there are no problems with the decisions they are making. and given power and responsibility to make certain decisions about the care all business and excuses being laid aside, you and each ofa proceeding for a guardian started? WE COMMAND YOU, that of another individual. »» How is you attend before , the Honorabledecisions might include treatment decisions at the Court These located at If the individual has County of or where the individual should live. Any person interested in the individual's welfare may in roomreduced life expectancy due to advanced illness, the , on the day of , 20 , at o'clock in the noon, and a Petition for complete aat any recessedAppointment of Guardian of or adjourned date, to testify and giveto make an a witness in this action on the part of the evidence as informed deciguardian may have power Incapacitated Individual (form PC 625) and file it, sion on behalf of the individual regarding receiving, along with the filing fee, with the probate court where continuing, discontinuing, or refusing medical treatthe individual resides or is presently located. Your failure to comply with this are listed punishable ment. The duties of a guardian subpoena isin statute. as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all lawyer necessary? »» Is a damages sustained as a result A your failure to comply. make all decisions for the of full guardian can individual. A limited guardian, can only make the No, but a lawyer can be helpful, especially if someWitness, Honorable , one of the Justices of the decisions for the individual that the court allows. one objects to the appointment of a guardian, the Court in County, day of , 20 authority you are asking to be given, or the person »» When can the court appoint a guardian? you are asking to be appointed guardian. The court can appoint a guardian when it finds the (Attorney must sign above and type name below) »» Can mediation be used for disagreements person is a legally incapacitated individual and about a guardianship? determines that a guardian is necessary. Attorney(s) for Certain disagreements about a request for a guardian may be mediated outside the court if all parties agree A legally incapacitated individual is an adult the court to attend mediation or if a judge order parties to attend finds to be so impaired by mental illness, mental mediation. The court clerk can tell you if mediation deficiency, physical illness or disability, chronic use Office and P.O. Address services are available in your court. of drugs, chronic intoxication, or other cause, that he or she lacks the understanding or capacity to make or communicate informed decisions. Telephone No.: »» What is a "legally incapacitated individual"? Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com Page 1 Defendant(s) : ...................................................... »» What happens when OF court accepts a petition THE PEOPLE OF THE STATEthe NEW YORK for filing? »» Can the individual get a guardian immediately in an emergency? TO After the petition is accepted for filing, the court will appoint a guardian ad litem to visit the individual to explain GREETINGS: the guardianship proceedings and to make recommendations to the court as a result of the visit. If an emergency exists, the judge may appoint a temporary guardian to serve until a hearing on the petition can be held. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the It is important for you to cooperate with the guardian ad Court Alternatives to a Full Guardian located atdoes not have the County of litem. The guardian ad litem in room day of , 20 , The o'clock in the The following five alternatives must be planned by noon, and at any recessed authority to, on the decisions for the individual. at make or adjourned date, to testify andpay for the guardian ad litem. Ifaction on the part of the individual before he or she becomes mentally give evidence as a witness in this individual may have to the necessary, the court may also order the individual to be incapable of making the decisions. examined by a physician or a mental health professional. to comply with this subpoena is punishable as a contempt of court and will make you liable to Attorney 1. Health Care Power of Your failure the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a advocate designation or a Also called a patient result What will the guardian ad litem do? of your failure to comply. »» durable power of attorney for health care. This document enables a person to name an agent Witness, Honorable , one of the Justices of thepatient advocate) to make his or her The guardian ad litem will personally visit the (called a Court individual andCounty, to the of in day individual the20 , nature, explain health care decisions when not capable or not purpose, and legal effects of the appointment of a competent to do so. The document may cover guardian. any type of health care decision including (Attorney must sign above and type name below) the agent about the type and extent guidance to The guardian ad litem will: of health care desired. It can also include 1) explain the hearing procedure and the authority to withhold or to withdraw life support individual's rights during the hearing; Attorney(s) for services. 2) inform the individual of the name of anyone seeking appointment as guardian; and 2. Do-Not-Resuscitate Order A do-not-resuscitate order is a document Office and P.O. Address directing that the patient named in the order not 3) inform the court of his or her be resuscitated if the patient's spontaneous respideterminations about the individual's wishes. ration and circulation stop in a setting outside a Telephone No.: nursing home, hospital, or mental health facility Facsimile No.: owned or operated by the Department of E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com Page 2 Defendant(s) : ...................................................... Community STATE The patient THE PEOPLE OF THE Health.OF NEW YORKmust sign the TO assets. document in the presence of his or her attending physician and two adult witnesses. Under a trust, assets are owned by the trust and managed by the trustee for the benefit of the If the patient is an adherent of a religious denomipersons to be protected. The trust also names nation or a church whose members depend upon the individuals to whom the assets will go upon GREETINGS: spiritual means through prayer alone for healing, the settlor's death. A trustee usually is the maker the COMMAND YOU, that alla do-not-resuscitate laid aside, you and each of you attend before and frequently names a adult patient may sign business and excuses being of the trust at first WE order relative to be the successor. Professional , the Honorable that meets special statutory requirements at the Court located at County ofand does not require the signature of an attending trustees often serve in this highly responsible in room physician. the , on day of , 20 , at o'clock in the noon, and at any recessed position. or adjourned date, to testify and give evidence as a witness in this action on the part of the 3. Power of Attorney 5. Joint Ownership A power of attorney is a document signed by a Joint ownership involves certain assets to be competent comply giving another person the held make you liable to Your failure toperson with this subpoena is punishable as a contempt of court and will by two or more persons and may entitle power to manage some or issued his or her any of the owners to the party on whose behalf this subpoena was all of for a maximum penalty of $50 and all damages sustained as a have control and manageresult of your failure The document must be signed by a affairs. to comply. ment of the assets. notary in the presence of at least one witness. Witness, Honorable , one of the Justices of of the assets that can be held in joint Some the attorney durable ownership are real estate, bank accounts, Court in A power ofCounty, is day of if it remains valid , 20 even if the maker of the power of attorney later corporate stocks, and mutual funds. A joint becomes disabled or incapacitated. A durable owner can apply the funds of an account for the power of attorney is the means for a mentally disabled co-owner without court action. This can (Attorney must sign above and type name below) competent adult to grant a person (called an involve the loss of sole control over the funds by agent) authority to act for him/her if incapacity the disabled person and can result in dishonest occurs. It usually affects property decisionuse of funds by the co-owner. Attorney(s) for making but may affect health care decisions. See the Health Care Power of Attorney stated in The following five alternatives do not need to be planned by the individual before he or she becomes item 1. mentally incapable of making the decisions. Office and P.O. Address 4. Trust A trust may be a substitute for a conservator and a 1. Limited Guardian will. The trust expresses the desires of the maker A guardian who makes only those decisions for the Telephone No.: (called a settlor) about the management of his Facsimile No.: or individual that the court allows. E-Mail Address: her assets during his or her lifetime and when Mobile Tel. No.: physically or mentally unable to manage the American LegalNet, Inc. www.USCourtForms.com Page 3 Defendant(s) : ...................................................... 2. Conservator THE PEOPLE OF THE STATE OF NEW YORK TO which he or she is the payee. A conservator is a person appointed by probate court and given power and responsibility for the estate (financial assets and property) of an adult (called a protected individual). 5. Special Services for the Aging Many communities have voluntary services available upon request to help the aging with their financial affairs. Services may include depositing GREETINGS: If an individual has property such as real estate, and writing checks, balancing checkbooks, paying large bank accounts, or stock that he and excuses no laid aside, you and each of preparingbefore or she can being bills, you attend insurance claims, preparing tax WE COMMAND YOU, that all business longer manage, it may be appropriate to file a Court information and counseling, and applying for public , the Honorable at the located at County ofpetition for a conservator. See separate instrucbenefits and counseling. in room tions on, Conservatorship Proceedings. , at on the day of , 20 o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the The Commission on Aging and the Family 3. Protective Order Independence Agency provide these services When only a single transaction affecting the in many communities as well as church organizaproperty of a disabled this subpoena is punishable as a contempt of court and will make you liable to of asking for or accepting person is required, the tions. A person capable Your failure to comply with the party probate court may enter a protective order maximum penalty of $50 and all damages sustained request the services to receive on whose behalf this subpoena was issued for a for this the services must as a result of your failurematter. to comply. one time them. Witness, Honorable At a hearing, the court may authorize, direct, or contract, trust, of other transaction Court in ratify any County, day or , 20 relating to that person's financial affairs or estate without appointing a conservator or a guardian. , one of the Justices of the (Attorney must sign above and type name below) 4. Representative Payee A representative payee is appointed by a government agency to receive, manage, and Attorney(s) for spend government benefits for a beneficiary. This is most often done for Social Security benefits. The beneficiary may request a representative payee, but usually the agency requires one when the and P.O. Address Office beneficiary is no longer able to manage benefits. A payee is approved by the agency and there is no Telephone No.: Facsimile No.: court involvement. The representative payee's E-Mail Address: authority is limited to the government funds for PC 666a (11/02) Approved, SCAO Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com Page 4