17-A Guardianship Proceeding Checklist of Intellectually Disabled/Developmentally Disabled Person (Person and/or Property) (see Surrogate's Court Form GMD-1, rev. 7/2016) Check All Forms To Make Sure Venue Is Correct - Appropriate County Is Listed Fill in All Areas On All Pages of Petition - Also Mark When Not Applicable Where Necessary PET ¶# This Checklist is provided for your convenience while completing the petition and the checklist need not be returned to the Court. DESCRIPTION YES NO Does the Court have jurisdiction over the subject ID/DDP, hereinafter referred to as respondent [see SCPA §1702]? NOTE: The respondent must be domiciled in the county, have sojourned in the county immediately preceding the application for guardianship, or if a non-domiciliary of the state, must have property situate in the county. The domicile of the respondent's parent(s) or spouse if respondent is married, or custodial parent in the case of an infant respondent is the domicile of the respondent. Is the captioned name the same as the birth certificate and ¶2 of petition? [see 22NYCRR §207.15(a) and SCPA §1752(1)] 1. Is the petitioner a proper party? [see SCPA §1751] Is the petitioner ... both parents or the survivor, or one parent; any person eighteen (18) years of age or older, including a corporation authorized to serve as a guardian, interested in the welfare of the respondent; the respondent when such person is eighteen (18) years of age or older. Complete all required information. Are all A/K/A's listed? 2a. Is the name and date of birth of the respondent in ¶2 the same as that listed on the Birth Certificate? [see SCPA §1752(1)] Attach Birth Certificate from official registrar (not hospital) to be filed with petition [see NYCRR §207.15(a)] Complete all required information. 2b. Check whether respondent is admitted to a group home or facility. [see MHL §1.03 and/or Article 15] If admitted, complete required information. 3. List the names and post office addresses of the parents and spouse of the respondent. [see SCPA §1752(3)] G17A-CHK release 3/24/2010 PAGE 1 American LegalNet, Inc. www.FormsWorkFlow.com PET ¶# 3. cont. DESCRIPTION If any relatives are deceased their names must still be shown and date of death noted. (Court may require copy of death certificate) If the name of the father is not shown on petition or birth certificate, determine if a proceeding has been brought to establish paternity. (Court may require copy of filiation order) [see page 5 - Comments & Court Notes] YES NO NOTE: If it is claimed that the identity of the father is unknown, the Court may require an affidavit showing diligent efforts to identify him. NOTE: If the natural mother was married at the time of respondent's birth, there is a rebuttable presumption that her husband is the father of the respondent and is a necessary party unless a filiation order has established otherwise. [see DRL §24(1)] 4. 5. 6. List names and addresses of adult children, adult siblings, and their relationship to respondent. [see SCPA §1752(3)] If the respondent has a primary care physician other than the physician submitting the certification, complete required information. If the father and mother are deceased, list the names and addresses of New York State distributees (those persons entitled to take a share of the respondent's property). [see EPTL §4-1.1] If respondent resides with person(s) other than parents or spouse, list names, addresses and relationship to respondent of person(s) charged with their care and custody. Give detailed information why those relatives listed in this paragraph are not petitioning to be appointed. This paragraph states that proposed guardian(s), standby or alternate standby guardian(s) are of sound mind, adult and competent. Choose the box that reflects the relief requested and indicate reasons. Choose the box that reflects the relief requested and indicate value. Describe and state the value of personal property as directed in this paragraph. [see SCPA §1752(6)] Describe and state the value of real property as directed in this paragraph. [see SCPA §1752(6)] Describe and state the value of annual income as directed in this paragraph. [see SCPA §1752(6)] State the source of all property as directed in this paragraph. NOTE: Court only requires information as to respondent's property. All information in paragraph 11 will be used to compare and verify the guardian's report on the first annual account. 7. 8. 9. 10a. 10b. 11a. 11b. 11c. 11d. G17A-CHK release 3/24/2010 PAGE 2 American LegalNet, Inc. www.FormsWorkFlow.com PET ¶# 12. DESCRIPTION Confirm that the licensed doctors' certifications (Form GMD-2A and 2B) are attached to petition and that their names and the dates of the certifications are completed on the petition. Check certifications/affidavits to be certain all required information is contained therein. [see SCPA §1750, 1750-a, 1750-b] For a limited guardianship, insert applicable employment information. [see SCPA §1756] List names and addresses of the proposed guardians (other than petitioner), all standby guardians or alternate guardians are listed and confirm that the boxes checked reflect the relief requested. Confirm that proper consents/oaths/designations or consents/designations are completed by any proposed alternate/standby guardians. (GMD-4) YES NO 13. 14a. to 14d. 15. Check appropriate box. If request is made to dispense with respondent's presence, confirm that physician's certification so attests or that other circumstances are stated. [see SCPA §1754] Confirm that the respondent has never had a guardian appointed by will or deed or any acting guardian in socage, or a guardian appointed pursuant to Social Services Law §384 or §284-b. [see SCPA §1704(3) and SCPA §1761] Check appropriate box. [see SCPA §1704(6) and §1761]. NOTE: If knowledge of a report is indicated, verify that an affidavit explaining circumstances in detail is included. 16. 17. 18. Confirm that Request for Information Guardianship form has been submitted. NOTE: Some Courts may require electronic fingerprinting for each proposed guardian in order to conduct a criminal record search. 19. 20. Check appropriate box. This paragraph states that there are no other persons interested in this proceeding other than those already mentioned. Confirm that any necessary waivers/renunciations/consents have been filed. (Form GMD-3) NOTE: SCPA §1753(1) requires that process shall issue to: 1. Parent or Parents (if other than p