DATE SCHEDULED FOR HEARING CONFERENCE STATEMENT DATE OF CONFERENCE FOR GUARDIANSHIP JUDGMENT IMO ____________________, COUNTY OF VENUE AN ALLEGED INCAPACITATED PERSON DOCKET NUMBER INSTRUCTIONS FOR COMPLETION OF CONFERENCE STATEMENT: COUNSEL FOR ALL PARTIES ARE EET AT LETO M AST 10 DAYS IN ADVANCE OF HEARING TO COMPLETE ALL PARTS OF THE STATEMENT. THATEMENE ST T IS DESIGNED TO FACILITATE DRAFTING OF THE FINAL JUDGMENT AND TO PROVIDE COURT THEWITH COMPREHENSIVE INFORMATION PRIOR TO THE HEARING. COUNSEL ARE TO INDICATE ALL AREAS IN WHICH THEY AGREE AND TO TE, IN NO APPROPRIATE SPACES, AREAS OF DISAGREEMENT BY CHECKING TH BOE X LABELED CONTESTED. FOER ALL ITEMS IDENTIFID AS CONTESTED, EACH ATTORNEY SHALL COMP LETE A COUNSELS STEMENT OF COAT NTESTED SSUES IFORM WHICH SHALL BE SUBMITTED WITH THIS CONFERENCE STATEMENT. COUNSEL SHALL PREPARE, AND ATTACH TO THIS SEMENT, A PROTAT POSED FORM OF JUDGMENT.A IF NY ISSUE IS CONTESTED, THAT FACT SHAE NLL BOTED ON THE PROPOSED FORM OF JUDGMENT AND SET FORTH INDETA IL ON COUNSELS STATEMENT OF CONTESTED ISSUES. THIS STATEMENT, THE PROPOSED FORM OF JUDGMENT AND COUNSELS STATEMENT OF CONTESTED ISSUES SHALL BE SUBMITTED AT LEAST 10 DAYRIOSR P TO THE HEARING DATE. TELEPHONE NUMBER 1. PLAINTIFFS COUNSEL FIRM NAME OFFICE ADDRESS NAME OF PARTY REPRESENTED TELEPHONE NUMBER DATE INTERVIEWED PROPOSED WARD 2. COURT APPOINTED COUNSEL FIRM NAME DATE OF COUNSELS REPORT TO COURT OFFICE ADDRESS NAME OF PARTY REPRESENTED TELEPHONE NUMBER 3. OTHER COUNSEL FIRM NAME OFFICE ADDRESS NAME OF PARTY REPRESENTED 4. IS THE PROPOSED WARD AN INCAPACITATED PERSON WHO IS UNFIT AND UNABLE TO GOVERNHIM SELF/HERSELF AND MANAGE HIS/HER AFFAIRS? Yes No Contested 5. SET FORTH THE NATURE OF THPROPOSEDE WARDS DISABILITY. Geriatric/Dementia Trauma induced Developmentally disabled individual (DDD)/reaching age of majority Other (set forth): ________________________________________________ __________________ American LegalNet, Inc. www.USCourtForms.com>>>> 2 SIDE 2 6. CAN THE PROPOSED WARD PARTICIPATE IN ANY DECISION-MAKING PROCESS (i.e. SHOULD THIS BE A LIMITED GUARDIANSHIP)? IF YES, INDICE ATBELOW THOSE AREAS IN WHICH THE WARD CAN MAKE OR PARTICIPATE IN THE DECISION-MAKING PROCESS. Yes No Contested AREAS OF DECISION MAKING RESERVED FOR PROPOSED WARD (ADD ADDITIONAL PAPER, IF NECESSARY). 7A. DOES PROPOSED WARD HAVE THE ABILITY TO PROVIDE INPUT 7B. IS THERE A DESIGNATION OF A GUARDIAN IN AN EXISTING POWER OF REGARDING SELECTION OF GUARDIAN? ATTORNEY? Yes No Contested Yes No 8. DOES THE PLAINTIFF SEEK, BY WAY OF RELIEF, ANY OF THE FOLLOWING? IF YES, CHECK ALL APPROPRIATE ARE AS.Yes No Revocation POA Approval of Medicaid/Asset Protection Planning Relocation of ward Approval of tax planning Rescind prior actions Approval of sale of real property Other (describe) _________________________________________________________________________ ____________________________________________________________________________________ NOTE: SET FORTH IN DETAIL, IN THE PROPOSED FORM OF JUDGMENT, ALL RELIEF REQUESTED. 9. DO COUNSEL AGREE TO THE PROPOSED RELIEF RED BYQUESTE PLAINTIFF AS REFLECTED IN BOX #8 ABOVE? Yes No Contested 10. DO COUNSEL AGREE THAT PETITIONER IS THAPPROPRIATE PERE SON TO SERVE AS GUARDIAN? Yes No Contested 11. IS A BOND REQUIRED? IF YES, SET FORTH PROPOSED AMOUNT OF BOND. Yes No Contested $_________________ 12. DOES THE PROPOSED WARD POSSESS SUFFICIENT ASSETS TO PAY A FEE TO COURT-APPOINTED COUNSEL? NOTE: THE COURT WILL SET THE FEE D ANCOUNSEL IS TO SUBMIT AN AFFIDAVITOF SERVICES WITH THIS STATEMENT. Yes No Contested 13. DOES THE PROPOSED WARD POSSESS SUFFICIENT ASSETS TO PAY A FEE TO PLAINTIFFS COUNSEL? NOTE: THE COURT WILL SET THE FEE AND COUNSEL IS TO SUBMIT AN AFFIDAVIT OF SERVICES WITH THIS STATEMENT. Yes No Contested 14. DOES COURT APPOINTED COUNSEL NEED TO CONTINUE IN THAT CAPACITY FOLLOWING THE HEARING?IF YES, O R IF THIS IS A CONTESTED ISSUE, EXPLAIN REASONS OR SET FORTH ANY DISPUTE ON THE COUNSELS STATENT OF COEM NTESTED ISSUES FORM. Yes No Contested 15. SHOULD THE GUARDIAN PROIDE AV NNUAL REPORTS? IF NOT, INDICATE WHY NOT. Yes No 16. DO COUNSEL AGREE TO THE PROPOSED FORM OF JUDGMENT? Yes No 17. WILL PROPOSED WARD BE PRESENT AT THE HEARING? Yes No 18. IS A JURY TRIAL REQUESTED? Yes No 19. SET FORTH ANY OTHER AREAS OF AGREEMENT BY COUNSEL NOT DEALT WITH ABOVE. 20. SET FORTH ANY OTHER AREAS OF DISAGREEMENT BY COUNSEL NOT DEALT WITH ABOVE. ATTORNEY SIGNATURE DATE COUNSEL FOR: ATTORNEY SIGNATURE DATE COUNSEL FOR: ATTORNEY SIGNATURE DATE COUNSEL FOR: American LegalNet, Inc. www.USCourtForms.com