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State of Rhode Island and Providence Plantations Probate ......PC-2.3 (Rev. 11/19) Page 3 of 3 DECREE This cause having come on to be heard after being duly advertised according to

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Text of State of Rhode Island and Providence Plantations Probate ......PC-2.3 (Rev. 11/19) Page 3 of 3...

  • DATE FILEDFOR

    COURT USE ONLY

    Name ofPetitionerhereby petitions the Probate Court of the City/Town of to appoint a limited

    guardian/guardian for , who currently resides at:

    Street Address

    City/Town State Zip Code

    and whose date of birth is: .

    Respectfully requests:Name of Nominee

    Relationaship to Respondent

    Street AddressCity/Town State Zip Code

    Name of Co- Nominee (if any)

    Relationaship to Respondent

    Street AddressCity/Town State Zip Code

    or some suitable person be appointed to said trust. Form PC-9.1, Waiver, if applicable. Based on an assessment conducted by:Name of AssessorDate of Assessment

    which assessment reflects the current level of functioning of the respondent, ,

    it has been determed that the respondent, , lacks decision-making ability in one or

    more of the following areas as indicated:

    Check applicable areas: Describe specific assistance needed: Health Care

    Financial Matters

    Residence

    PETITION FOR LIMITED GUARDIANSHIP OR GUARDIANSHIPRIGL 33-15-1 et seq. & RIGL 33-15-47

    PC-2.3 (Rev. 11/19)

    State of Rhode Island and Providence PlantationsProbate Court

    Page 1 of 3

    STATE OF RHODE ISLANDCounty of

    Estate of

    Alias

    PROBATE COURT OF THECity or Town of

    No.

    http://webserver.rilin.state.ri.us/Statutes/TITLE33/33-15/33-15-1.HTMhttp://webserver.rilin.state.ri.us/Statutes/TITLE33/33-15/33-15-47.HTM

  • Association

    Other

    Indicate which of the following less restrictive alternatives to guardianship have been explored and deemed inappropriate as indicated: Durable Power of Attorney for Health Care

    Living Will

    Power of Attorney

    Durable Power of Attorney

    Trusts

    Joint Property Arrangements

    Representative Payee

    Money Management

    Single Court Transactions

    Government Benefits and Social Service Programs

    Housing Options

    Other

    Please describe the basis for the determination that the alternative will not meet the needs of the respondent for each alternative explored and deemed inappropriate.

    The following individual/agency is willing to serve as guardian:

    Upon information and belief the above individual/agency has:

    No conflict of interest that would interfere with guardianship duties.

    No criminal background that would interfere with guardianship status.

    The capacity to manage financial resources involved.

    The ability to meet requirements of law and unique needs of individual.

    Demonstrated willingness to undergo training.

    PC-2.3 (Rev. 11/19) Page 2 of 3

  • PC-2.3 (Rev. 11/19) Page 3 of 3

    DECREEThis cause having come on to be heard after being duly advertised according to law, it is hereby ordered, adjudged and

    decreed that be appointed guardian of the person and estate of

    , bond to be filed in the amount of $ .With SuretyWithout Surety

    Entered as an order and decree of the court on:Name ofProbate Judge

    Date

    Signature of Probate Judge

    Petitioner: To the best of my knowledge or belief, the statement(s) contained within this document are truthful and accurate.Signature of Petitioner

    Date

    Street Address

    City/Town State Zip Code

    Email PhoneNumber

    Notary:Name of Notary State County

    On day of , 20 the petitioner, known to me or proved through satisfactory evidence, signed the document in my presence and swore or affirmed the statement(s) in the documents is/are truthful and accurate.

    Signature of Notary Public Date

    Commission ID# Commission Expiration Date Notary Seal

    The respondent has the following heirs at law:

    NAME RELATIONSHIP RESIDENCE

    Attach form PC-9.1 Waiver, if applicable.

    PETITIONER SIGN HERE

    NOTARY SIGN HERE

    PROBATE JUDGE SIGN HERE

    Combo Box 1: [Select County]2: 3: Combo Box 4: [Select City or Town]5: 26: 27: 28: 29: 30: 31: 32: 33: 34: 35: 6: 10: 11: 12: 8: 9: 13: 7: [Select City or Town]14: 15: 16: 17: 18: 19: 20: 21: 22: 23: 24: 25: 40: 41: 42: 43: 46: 44: 45: 36: 37: 38: 39: 87: 88: 89: 90: 84: 79: 80: 85: 86: 78: 81: 82: 83: 71: 73: 74: 76: 72: 75: 77: 48: 49: 51: 52: 54: 55: 57: 58: 60: 61: 63: 64: 66: 67: 47: 50: 53: 56: 59: 62: 65: 69: 70: 68: 91: Check Box1: OffCheck Box2: OffCheck Box3: OffCheck Box4: OffCheck Box5: OffCheck Box6: OffCheck Box7: OffCheck Box8: OffCheck Box9: OffCheck Box10: OffCheck Box11: OffCheck Box12: OffCheck Box13: OffCheck Box14: OffCheck Box15: OffCheck Box16: OffCheck Box17: OffCheck Box18: OffCheck Box19: OffCheck Box20: OffCheck Box21: OffCheck Box22: OffCheck Box23: OffCheck Box24: Off