IN THE COURT OF COMMON PLEAS OF CHESTER COUNTY, PENNSYLVANIA IN RE: , an alleged incapacitated person Docket No. : 15 - NOTICE TO THE COURT OF NON REPRESENTATION OF ALLEGED INCAPACITATED PERSON The Petitioner in the above matter, , pursuant to 20 Pa.C.S. 2475511(A)(II)(2), notifies the Court that neither he/she nor their counsel has knowledge of any legal counsel who has been retained by or on behalf of the alleged incapacitated person in the above matter. (check one): The petitioner (s) know (s) or has /have reason to believe the following circumstances exist that may make it appropriate for the Court to appoint counsel for the alleged incapacit ated person: OR The petitioner(s) know(s) of no circumstances that may make it appropriate for the Court to appoint counsel for t he alleged incapacitated person. I verify that the statements made in the foregoing NOTICE TO THE COURT OF NON REPRESENTATION OF ALLEGED INCAPACITATED PERSON are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. 2474904, relating to unsworn falsification to authorities. (Date) (S ignature) (Date) (Signature) American LegalNet, Inc. www.FormsWorkFlow.com