IN THE COURT OF COMMON PLEAS OF CHESTER COUNTY, PENNSYLVANIA IN RE: , an incapacitated person Docket No. : 15 - PETITION FOR EMERGENCY TEMPORARY GUARDIAN PRELIMINARY DECREE AND NOW, this day of , 20, upon consideration of the attached petition and on the motion of , Esquire, Counsel for the petitioner, it is Ordered and Decreed that a Citation be awarded, returnable forthwi th, to, to show cause why (she/he) should not be adjudged an incapacitated person and an emergency guardian of (her/his) (estate/person) should not be appointed. A Hearing on the petition for appointment of emergency guardian is sched uled for: ,the day of , 20, at : am/pm, prevailing time, in Courtroom of the Chester County Justice Center, West Chester, Pennsylvania, before the Honorable . Notice of the hearing on the appointment of the emergency guardian shall be given to the alleged incapacitated person by serving (her/him) personally with the Citation with Notice and this Preliminary Decree and copy of the petit ion. Notice shall also be given to the next of kin and presumptive heirs, service providers and other parties in interest as set forth in the Order by personal service, registered mail or certified mail. [ LIST PERSONS TO WHOM NOTICE IS TOBE GIVEN : ] O R The Court finds that under the circumstances only the following next of kin and presumptive heirs, service providers and other parties in interest shall be notified of the hearing by personal service, registered mail, certified mail or other. [ LIST PERSONS TO WHOM NOTICE IS TO BE GIVEN : ] BY THE COURT: J. American LegalNet, Inc. www.FormsWorkFlow.com