File No. SURROGATE222S COURT- COUNTY17-A GUARDIANSHIP CITATION [SCPA 1757]THE PEOPLE OF THE STATE OF NEW YORKBy the Grace of God Free and IndependentTO:A petition having been filed by , who is/aredomiciled at YOU ARE HEREBY CITED TO SHOW CAUSE before the Surrogate222s Court, County,at , New York , on , , at o222clock in the noon of that day, why letters of guardianship of the[ ] person[ ] property[ ] person and property[ ] limited guardianship of the propertyof should not be granted to ;why the appointment of as Alternate Standby Guardian of the[ ] person[ ] property[ ] person and property[ ] limited guardianship of the propertyof should not be granted;why the appointment of as Second Alternate Standby Guardian of the[ ] person[ ] property[ ] person and property[ ] limited guardianship of the propertyof should not be granted;why the appointment of as Third Alternate Standby Guardian of the[ ] person[ ] property[ ] person and property[ ] limited guardianship of the propertyof should not be granted;and why a hearing [ ] should be held [ ] should not be held;and why the appearance of Respondent [ ] should be [ ] should not be required at the hearing;and why the guardian of the person should not be authorized and empowered to make all decisions with respect to the medicaland dental needs of the Respondent and to render consent to any medical procedures which are necessary to the health andwelfare of the Respondent, unless the court directs otherwise. A health care decision may include a decision to withhold orwithdraw life-sustaining treatment as defined in subdivision (j) of 81.03 of the Mental Hygiene Law.[State further relief requested]Dated, Attested and Sealed,HON., ,Surrogate(Seal) , Chief ClerkAttorney for Petitioner(s): Telephone Number: Address of Attorney: [Note: This citation is served upon you as required by law. You are not required to appear. However, if you fail to appear it will be assumed bythe court that you do not object to the relief requested. You have a right to have an attorney appear for you.]CSMD-4 (/201) American LegalNet, Inc. www.FormsWorkFlow.com