COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Probate .Court Form No. 74 .... .. .. : Petition to Appoint A Voluntary Guardian for an Infirm Person Page 1 of 2 STATE OF VERMONT DISTRICT OF _______________________Plaintiff(s) -againstIN RE _______________________________ Index No. : Calendar No. PROBATE COURT : JUDICIAL SUBPOENA : DOCKET NO. __________________ : : Defendant(s) : ...................................................... PETITION TO APPOINT VOLUNTARY GUARDIAN FOR AN INFIRM PERSON THE PEOPLEundesigned petitioner requests that the court appoint a guardian to assist in the management of The OF THE STATE OF NEW YORK my affairs. I state that I am more than 18 years of age (my date of birth is ___________ ) and I am not TO mentally ill or mentally retarded. The approximate value of my real estate is $ _______________ . The approximate value of my personal property is $ __________________ . (Financial information may be omitted in applications for GREETINGS: limited guardianships for medical purposes only.) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before I have attached the entry fee. , the Honorable at the Court located at County ofI request that the court appoint as my guardian: in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date,Name to testify and give evidence as a witness in this action on the part of the Residence Relationship ________________________ ________________________ ___________________ I request that the guardian have the following powers. (Check applicable requests). Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a ( 1. to exercise result of your) failure Tocomply. general supervision over me; ( ) 2. To approve or withhold approval of any contract, except for necessaries, which I wish to make; Witness, Honorable , or of the way encumber ( ) 3. To approve or withhold approval of my request to sellone in any Justices of the my Court in County, day of , 20 personal or real property; ( ) 4. To exercise general supervision over my income and resources; ( ) 5. To consent to surgery or other medical procedures, subject to the provisions of 14 V. S. A. Section 3075 and any constitutional right of mine to refuse above and type name below) (Attorney must sign treatment; ( ) 6. To receive, sue for, and recover debts and demands due me, to maintain and defend actions or suits for the recovery or protection of my property or person, settle accounts, demands, claims, and actions at law or in equity against me, including actions for injuries Attorney(s) for to my property or person, and to compromise, release, and discharge the same on those terms as the guardian deems just and beneficial to me. Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Probate .Court Form No. 74 .... .. .. : Petition to Appoint a Voluntary Guardian for an Infirm Person Page 2 of 2 Index No. : Plaintiff(s) Check one of the following: -against- Calendar No. : JUDICIAL SUBPOENA : ( ) I will physically appear before the court, or : ( ) I will not be able to physically appear before the court, but the petition is accompanied by a letter from a physician or qualified mental health professional stating that I understand the nature, : extent and consequences of the guardianship requested and the procedure for revoking the guardianship. Defendant(s) : ...................................................... I consent to be appointed guardian of the above petitioner. THE PEOPLE OF THE STATE OF NEW YORK Dated __________________________ Signed _________________________ TO Proposed Guardian Address _________________________ Telephone No. ____________________ GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com