Visitors Report Form. This is a Minnesota form and can be use in District Court Statewide.
Tags: Visitors Report, GAC-105, Minnesota Statewide, District Court
State of Minnesota District Court Probate Division Judicial District: Court File No. Case Type: 14, Conservatorship Guardianship County of VISITOR’S REPORT In Re: Guardianship Conservatorship of 1. Date of Interview: Place: Others present during the interview: 2. Person oriented as to time and place. Knowledge of: Time of day: Date: Place: 3. Physical appearance: 4. Were the notice and petition read to the Respondent? 5. Questions put to the person and his/her responses: A) Do you understand the nature, purpose and effect of these proceedings? B) You have a right to attend the hearing on this petition. Do you wish to attend? Was a waiver signed? GAC105 State ENG Rev 4/05 www.mncourts.gov/forms Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com C) The law requires that the Court appoint an attorney to represent you, unless you wish to hire your own, or an attorney is provided by others, or you waive, in writing, the right to have an attorney. If you can afford it, you must pay reasonable attorney’s fees for the attorney you hire, or the attorney appointed by the Court. Do you understand what I have told you? Do you want to have the Court-appointed attorney? Do you wish to waive your right to be represented by an attorney? Was a waiver signed? You have a right to hire your own attorney. If an attorney is to be retained: What is his/her name? If an attorney is to be appointed by the Court: ______________________________ is the Court-appointed attorney who will be available to represent you. Was a copy of the Order Appointing Attorney given to the Respondent? D) Which of your family members is closest to you and in whom do you have trust and confidence? E) Who are your other family members? F) Do you know ______________________________, guardians/conservators? the proposed Would you like to be appointed your guardian/conservators, or neither? If neither, is there someone you would prefer to be your guardian/conservator? Who? GAC105 State ENG Rev 4/05 www.mncourts.gov/forms Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com What powers would you like the guardian/conservator to have: 6. 7. The power to have custody of you and be responsible for finding you a place to live? 2) The power to provide for your care, comfort and needs? 3) The power to take care of your personal belongings? 4) The power to provide for medical care and treatment? 5) The power to be responsible for any contracts you make? 6) The power to have supervision over you? 7) The power to pay for your support and maintenance? 8) The power to pay your debts? 9) The power to have and manage your estate? Report on residence: A) Is place visited the Respondent’s place of abode? B) Type of abode: C) Address: D) General condition of abode, if a private residence: Conclusions of Visitor: A) GAC105 1) The nature and degree of the person’s current incapacity or disability is as follows: State ENG Rev 4/05 www.mncourts.gov/forms Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com GAC105 B) If guardianship: It seems appropriate to grant the following powers: Have custody of the Ward and establish the place of abode for the Ward within or without the State, M.S. § 524.5-313 (c)(1); Provide for the Ward’s care, comfort and maintenance needs, M.S. § 524.5-313 (c)(2); Take reasonable care of the Ward’s clothing, furniture, vehicles and other personal effects, M.S. § 524.5-313 (c)(3); Give any necessary consent to enable, or to withhold consent for, the Ward to receive necessary medical or other professional care, counsel, treatment or service, M.S. § 524.5-313 (c)(4); Approve or withhold approval of any contract, except for necessities, which the Ward may make or wish to make (only given if no conservator is appointed), M.S. § 524.5-313 (c)(5); Exercise supervision authority over the Ward, M.S. § 524.5-313 (c)(6); Apply on behalf of the Ward for any assistance, services, or benefits available to the Ward through any unit of government, M.S. § 524.5-313 (c)(7); (other)__________________________________________________________.. C) If conservatorship: It seems appropriate that the following powers be granted to the conservator: Pay reasonable charges for the support, maintenance, and education of the Protected Person in a manner suitable to the Protected Person's station in life and the value of the Protected Person’s estate, M.S. § 524.5-417 (c)(1); Pay out of the Protected Person's estate all lawful debts of the Protected Person, M.S. § 524.5-417 (c)(2); Possess and manage the estate of the Protected Person, collect all debts and claims in favor of the Protected Person, or with the approval of the court compromise them, institute suit on behalf of the Protected Person and represent the Protected Person in court proceedings, and invest pursuant to M.S. § 48A.07 and 501B.151 all funds not currently needed for debts, charges, and management of the estate, M.S. § 524.5-417 (c)(3); Exchange or sell an undivided interest in real property, M.S. § 524.5-417 (c)(4); Approve or withhold approval of any contract, except for necessities, which the Protected Person may make or wish to make, M.S. § 524.5-417 (c)(5); Apply on behalf of the Protected Person for any assistance, services, or benefits available to the Protected Person through any unit of government, M.S. § 524.5417 (c)(6); and (other)___________________________________________________________. State ENG Rev 4/05 www.mncourts.gov/forms Page 4 of 5 American LegalNet, Inc. www.FormsWorkFlow.com 8. Additional comments: A. Living arrangement preference of the Respondent: B. Any need for an attorney (even though the Respondent indicates otherwise or is unable to make an expression). C. Other: 9. I informed the Respondent that I would be preparing this report and that a copy of it would be available to him/her and his/her attorney, not later than 5 days prior to the hearing. 10. I, the Visitor, have no personal interest in these proceedings. __________________________________ Signature of Court Visitor Dated:________________________ GAC105 State ENG Rev 4/05 www.mncourts.gov/forms Page 5 of 5 American LegalNet, Inc. www.FormsWorkFlow.com