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Filing Attorney Information or Pro Se Litigant: Name NJ Attorney ID Number Law Firm/Agency Name Address Telephone Number In the Matter of: , an Incapacitated Person Superior Court of New Jersey Chancery Division - Probate Part County Docket No. Civil Action Judgment of Incapacity and Appointment of Guardian(s) of the Person and Estate THIS MATTER being opened to the Court by , plaintiff(s), by and through his/her attorney, in the presence of , attorney for the then alleged incapacitated person, and , the then alleged incapacitated person, and no demand having been made for a jury trial, and the Court sitting without a jury having found from the report of counsel together with the report of the examining physician or psychologist and other supporting document and proofs given that is an incapacitated person who lacks sufficient capacity to govern himself/herself or to manage his/her affairs, and it further appearing that , consents to serve as Guardian(s) of the Person and Estate (Property) of , and for good cause shown: IT IS on this day of , 20 , ORDERED AND ADJUDGED that: 1. GUARDIANSHIP TYPE: As to the Person As to the Estate is an incapacitated person and is unfit and unable to govern himself/herself and manage his/her affairs. This is a guardianship: General General Limited Limited Limited Guardianship: The incapacitated person is able at this time to govern himself/herself and manage his/her own affairs with respect to the following areas: Check if applicable: The subject of this guardianship is incapacitated as a result of developmental disability. Firearms: Pursuant to 18 U.S.C. 922(g)(4), the incapacitated person does not retain the right to possess firearms. 2. GUARDIAN APPOINTMENT: be and hereby is/are appointed Guardian(s) of the Person and Estate of the incapacitated person and that Letters of Guardianship of the Person and Estate be issued upon his/her/their (a) qualifying according to law, (b) acknowledging to the Surrogate completion of guardianship training and receipt of the guardianship training guides, and (c) unless waived for extraordinary reasons, entering into a surety bond unto the Superior Court of New Jersey in the page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Revised: 02/2017, CN 11802 (Judgment of Incapacity and Appointment of Guardian(s) of the Person and Estate) amount of $ , which bond shall contain the conditions set forth in N.J.S.A. 3B:15-7 and R. 1:13-3. The court shall approve the bond as to form and sufficiency. 3. Upon qualifying, the Surrogate shall issue Letters of Guardianship of the Person and Estate to and thereupon the guardian(s) be and hereby is/are authorized to perform all the functions and duties of a Guardian of the Person and Estate as allowed by law, except as limited herein or in areas where the incapacitated person retains decision making rights. 4. In exercising the authority conferred by this Judgment, the guardian(s) shall: · · · · · · Ascertain and consider those characteristics of the incapacitated person which define his/her uniqueness and individuality, including but not limited to likes, dislikes, hopes, aspirations, and fears; Encourage the incapacitated person to express preferences and participate in decision-making; Give appropriate deference to the expressed wishes of the incapacitated person; Protect the incapacitated person from injury, exploitation, undue influence, and abuse; Promote the incapacitated person's right to privacy, dignity, respect, and self-determination; and Make reasonable efforts to maximize opportunities and individual skills to enhance self-direction. 5. GUARDIAN LIMITATIONS: If applicable, the authority of the guardian(s) is limited as follows, and all limitations shall be stated in the Letters of Guardianship. The Guardian(s) of the Estate may not alienate, mortgage, transfer or otherwise encumber or dispose of real property without court approval. 6. The guardian(s) appointed hereunder shall be considered the personal representatives under the Standards for Privacy of Individually Identifiable Health Information ("Privacy Rule") issued pursuant to the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), and shall have full and complete access to all records of the incapacitated person. 7. INVENTORY: The Guardian(s) shall file with the Court an inventory of all of the incapacitated person's property and income, along with a Report of Guardian Cover Page, within 90 days. Said inventory shall be available for inspection by any party in interest in this guardianship action, upon request to the Surrogate's Court to review the inventory. 8. REPORTING AS TO PERSON: , as Guardian(s) of the Person, is/are hereby directed to file annually a report of the well-being of the incapacitated person, along with a Report of Guardian Cover Page. OR The filing of a report of well-being is hereby waived for the reasons stated on the record. 9. REPORTING AS TO ESTATE (PROPERTY): , as Guardian(s) of the Estate, is/are directed to file annually, along with a Report of Guardian Cover Page.. Formal accounting (presumptive if guardianship estate valued over $5,000,000); Comprehensive accounting (presumptive if guardianship estate valued $1,000,000 - $5,000,000); EZ accounting (presumptive if guardianship estate valued under $1,000,000); or American LegalNet, Inc. www.FormsWorkFlow.com Revised: 02/2017, CN 11802 (Judgment of Incapacity and Appointment of Guardian(s) of the Person and Estate) page 2 of 3 Copy of the Social Security Representative Payee Report (presumptive if guardian is also representative payee for Social Security benefits and incapacitated person has no other assets or income); OR The filing of a Periodic Accounting is hereby waived for the reasons stated on the record. If an informal accounting is ordered, said Periodic Accounting does not replace or satisfy the duty to file and bring on for approval a formal accounting as required by law or as ordered by the court. 10. The report(s) indicated in paragraphs 8 and/or 9 above is/are to be filed not later than fourteen (14) days after the anniversary date of this judgment with the County Surrogate. The re