Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Interrogatories Form. This is a Missouri form and can be use in 22nd Circuit (St. Louis City) Local Circuit Courts.
Loading PDF...
Tags: Interrogatories, Missouri Local Circuit Courts, 22nd Circuit (St. Louis City)
Submit by Email
Print Form
MISSOURI CIRCUIT COURT, TWENTY-SECOND JUDICIAL CIRCUIT
PROBATE DIVISION, CITYOF ST. LOUIS
In the Matter of
No.
Respondent
DEPOSITION OF __________________________________________________________
On this ________ day of _________________, _______, before me,
,a
Notary Public within and for the State of Missouri, personally appeared ___________________________,
M.D., who, after being first duly sworn, testified as follows:
INTERROGATORIES
1.
Q. State your name, age and residence.
A.
2.
Q. What is your occupation, business or profession?
A.
3.
Q. Are you licensed to practice medicine in the State of Missouri?
A.
4.
Q. If your answer to Interrogatory number 3 above is affirmative, is your license subject to any
restrictions imposed by the Board of Healing Arts of the State of Missouri?
A.
5.
Q. If in your practice you specialize in some particular field, please specify same.
A.
6.
Q. Are you self-employed? ________. If not, where are you employed and in what capacity?
A.
7.
Q. Are your duties as a physician such as will prevent your attendance in court as a witness in this
cause?
A.
8.
Q. Are you acquainted with ________________________________________________________?
A.
9.
Q. Have you had occasion to examine, observe and treat _________________________________?
A.
10.
Q. What was the date of such examination, or between what dates has _______________________
American LegalNet, Inc.
www.FormsWorkflow.com
been under your observation?
A.
11.
Q. Give the symptomatology which you observed and both the neurological and mental diagnoses
which you have made, based upon your examination and observation of
.
PLEASE STATE FULLY THE FACTS UPON WHICH YOUR DIAGNOSTIC CONCLUSIONS
ARE BASED – NOT ACCEPTABLE AS EVIDENCE OTHERWISE.
A.
IF APPLICATION IS FOR APPOINTMENT OF A GUARDIAN OF THE PERSON:
12.
to be “incapacitated,” that is, unable
Q. Do you consider
by reason of any physical or mental condition to receive and evaluate information or to
communicate decisions to such an extent that he/she lacks ability to meet his/her essential
requirements for food, clothing, shelter, safety, or medical care such that serious physical
injury, illness, or disease is likely to occur were a guardian not appointed for him/her?
A.
13.
Q. Please describe the physical and/or mental conditions upon which your answer to
Interrogatory 12 is based.
A.
IF APPLICATION IS FOR APPOINTMENT OF A CONSERVATOR OF THE ESTATE:
American LegalNet, Inc.
www.FormsWorkflow.com
14.
Q. Do you consider
to be “disabled,” that is, unable
by reason of any physical or mental condition to receive and evaluate information or to
communicate decisions to such an extent that he/she lacks ability to manage his/her financial
affairs?
A.
15.
Q. Please describe the physical and/or mental conditions upon which your answer to
Interrogatory 14 is based.
A.
16.
Q. Do you consider it for
appointment of a guardian to protect his/her person?
‘s best interest to bring about the
A.
17.
‘s best interest to bring about the
Q. Do you consider it for
appointment of a conservator to manage his/her resources?
A.
18.
Q. Do you consider
mind?
to be “incompetent,” i.e., of unsound
A.
19.
Q. State anything further you may have to say regarding the alleged disability, incapacity, or
.
incompetence of
A.
American LegalNet, Inc.
www.FormsWorkflow.com
___________________________________
DEPONENT
_____________________________________
WITNESS
KNOW ALL MEN BY THESE PRESENTS, that I, the undersigned Notary Public, hereby certify that
the above-named deponent was first duly sworn by me to make true answers to the foregoing interrogatories,
that said interrogatories were read by me to deponent, that the answers thereto are correctly recorded as
hereinabove set forth, that this deposition was subscribed to by the deponent and witness in my presence.
___________________________________
NOTARY PUBLIC
My Commission Expires: _________________
American LegalNet, Inc.
www.FormsWorkflow.com
