Free Stipulation For Introduction Of Interrogatories - Missouri

IN THE PROBATE DIVISION, CIRCUIT COURT ST. LOUIS COUNTY, MISSOURI

In the matter of: ____________________________________

Estate No.

STIPULATION FOR INTRODUCTION OF INTERROGATORIES
It is hereby stipulated and agreed that the deposition of _________________________________ ______________________________________________________________________________ ______________________________________________________________________________ be taken by a Notary Public on the interrogatories set forth herein and when signed by the Deponent and certified to by the Notary Public, may be read in evidence at the hearing of the above entitled matter, all notice and cross interrogatories being waived.

__________________________________________ Attorney for Petitioner

__________________________________________ Attorney for Respondent

5075/D

IN THE PROBATE DIVISION, CIRCUIT COURT ST. LOUIS COUNTY, MISSOURI
In the matter of: __________________________________________ Respondent Deposition of ________________________________________________
Select a Month On this ______ day of__________________, 2_____, before me,________________________,

Estate No.

a Notary Public within and for the County of ______________, State of Missouri, personally appeared ____________________________, who, after being sworn, testified as follows:

INTERROGATORIES
1. Q. Please state your name, age and residence. A.

2.

Q. What is your occupation, business or profession? A.

3.

Q. Are you licensed to practice medicine in the State of Missouri? A.

4.

Q. If your answer to Interrogatory number 3 above is affirmative, is your license subject to any restrictions imposed by the Board of Healing Arts of the State of Missouri? A.

5.

Q. Where are you employed and in what capacity? A.

6.

Q. Are you acquainted with ____________________? A.

7.

Q. Have you had occasion to examine, observe and treat ____________________? A.

8.

Q. What was the date of such examination, or between what dates has ________________________ been under your supervision? A.

9.

Q. Give the symptomatology which you observed and both the neurological and mental diagnoses which you have made, based upon your examination and observation of ________________________. PLEASE STATE FULLY THE FACTS UPON WHICH YOUR DIAGNOSTIC CONCLUSIONS ARE BASED ­ NOT ACCEPTABLE AS EVIDENCE OTHERWISE. A.

10.

Q. Do you consider _____________________ to be "disabled," that is, unable by reason of any physical or mental condition to receive and evaluate information or to communicate decisions to such an extent that he/she lacks ability to manage her financial affairs? A.

11.

Q. Please describe the physical and/or mental conditions upon which your answer to Interrogatory 10 is based. A.

12.

Q.

Do you consider _____________________ to be "incapacitated," that is, unable by reason of any physical or mental condition to receive and evaluate information or to communicate decisions to such an extent that he/she lacks ability to meet his/her essential requirements for food, clothing, shelter, safety, or medical care such that serious physical injury, illness, or disease is likely to occur were a guardian not appointed for him/her?

A.

13.

Q.

Please describe the physical and/or mental conditions upon which your answer to Interrogatory 12 is based.

A.

14.

Q.

Do you consider it for ____________________'s best interest to bring about the appointment of a guardian to protect his/her person?

A.

15.

Q.

Do you consider it for _____________________'s best interest to bring about the appointment of a conservator to manage his/her resources?

A.

16.

Q. Do you consider _____________________ to be "incompetent," i.e., of unsound mind?

A.

17.

Q. State anything further you may have to say regarding the alleged disability, incapacity, or incompetence of _____________________. A.

__________________________________________ Deponent

KNOW ALL MEN BY THESE PRESENTS, that I, the undersigned Notary Public hereby certify that the above named Deponent was first duly sworn by me to make the true answers to the foregoing interrogatories; that said interrogatories were read by me to Deponent; that the answers thereto are correctly recorded as hereinabove set forth; and that this deposition was subscribed by the Deponent in my presence. __________________________________________ Notary Public

My commission expires: _______________