Free Instructions - New Hampshire

Instructions for completing Petition for Guardian of Incapacitated Person
(NHJB-2165-P)

Form use. This form is used to ask the court to appoint a guardian for an incapacitated person, usually an adult. Top section of form ·COURT NAME: Enter the name of the county probate court where the document will be filed. (example: Belknap County Probate Court; Rockingham County Probate Court). ·CASE NAME: Enter the name of the case (example: Guardianship of John Adams; Guardianship of Susan Jones). ·CASE NUMBER: Leave blank if not yet assigned by court OR fill in case number if it is known. Numbered section of form 1. Petitioner Name is the name of the person filing the petition. Enter that person's name, telephone number and complete mailing address with zip code. The ward is the person who will be under guardianship due to his/her inability to take care of personal needs for health care, food, shelter, clothing or safety, and/or manage an estate. Examples of relationship to the ward are mother, father, son, brother, friend, etc. 2. If the petitioner has an attorney assisting with this case, enter his or her name, telephone number, firm name, NH bar identification number and complete mailing address including zip code. If there is no attorney, leave blank. Proposed ward name is the name of the person who is being placed under guardianship. Enter that person's date of birth, telephone number and complete mailing address with zip code. Enter the name of the person or institution currently responsible for caring/custody of the proposed ward. Also enter the telephone number and complete mailing address with zip code. Proposed guardian name is the name of the person who will provide for the care and management of the proposed ward. Also, enter their date of birth, relationship to proposed ward, occupation, complete mailing address with zip code, and telephone number. Specify if there is a written document in which the proposed ward has identified a person he/she wants to be guardian by checking off one box ­ yes or no. If yes, enter the name, complete address with zip code and telephone number of the nominated guardian. Enter the name, complete address with zip code and telephone number of the attorney for the proposed ward. The court will appoint an attorney if the proposed ward does not have one. List the name of the ward's spouse, parents, all adult children & all adult siblings. Write each person's complete address with zip code and the relationship of each person to the ward. The law states that these individuals are to be notified of the guardianship hearing. This applies to all persons indicated in first sentence, even though the proposed ward may not have had contact with these persons in a long time.

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NHJB-2165-P Instructions (12/01/2008)

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Check off one box ­ yes or no ­ to indicate whether or not the proposed ward has a document for durable power of attorney? If yes, please provide a copy of that document to the court. Check off one box ­ yes or no ­ to indicate whether or not the proposed ward has a document for durable power of attorney for health care? If yes, please provide a copy of that document to the court. Check off one box ­ yes or no ­ to indicate whether or not the proposed ward has a documented living will? If yes, please provide a copy of the document to the court. Check off only one box, which describes the type or guardianship you are asking the court to grant. There are three options: person only, estate only, person and estate. · Guardianship over the Person Only would be used if the proposed guardian will provide the authority to make decisions about the ward's medical treatment as well as where the ward lives and travels. · Guardianship of the Estate Only would be used if the proposed guardian will provide the authority to make decisions about all of the ward's finances. · Guardianship over the Person and Estate Only would be used if the proposed guardian will provide the authority to make decisions about the ward's medical treatment, where the ward lives and travels, and all of the ward's finances. Check off only one box, indicating if this guardianship will be a temporary or long term guardianship? Temporary guardianship is for a period of 60 days. If temporary is selected, explain why a long term guardianship is inappropriate. Indicate the length of time you are requesting for this appointment by checking off the box for either indefinite time or enter a specific number of days, months or years.

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Complete Questions 15-17 only if you are requesting guardianship over the estate. If you are requesting guardianship over the person ONLY, go to question 18. 15. If the proposed ward owns real estate, whether solely owned, as tenants in common or jointly held property, please list: a.) the street address and city or town where each parcel is located; b.) the approximate value for each piece of property. Enter the total value of real estate on the line provided. List the personal property of the proposed ward including cash, bank accounts, vehicles, etc. and the approximate value of each item. Enter the total value of personal property on the line provided. List the sources and amount of income received by the proposed ward. Examples are Social Security, child support, alimony, etc. The petitioner requests the court find the ward incapable of exercising the rights selected from the list provided. Please read each listed item and check off the ones, which the ward is unable to perform. The petitioner must provide facts, in writing, that show a genuine need for guardianship. The petitioner should list all the basic needs (food, clothing, shelter, health care) that the proposed ward cannot provide for himself/herself. Describe in specific detail the most recent events/incidents that demonstrate his/her inability and the substantial harm it has or will cause as a result. All events of his/her inability must be within six (6) months. One event/incident must have occurred within 20 days of filing this petition.

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NHJB-2165-P Instructions (12/01/2008)

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Only if applying for guardianship over the estate, the petitioner must name an appraiser to take an inventory and appraise the estate. The appraiser named must reside in New Hampshire, have no interest in the estate, no relationship to the ward or be a party to this guardianship case. Enter the name and address of the appraiser on the lines provided.

Signature section This form must be signed in the presence of a Notary Public or Justice of the Peace. They will complete the section immediately following your signature. You will sign the form on the Petitioner's Signature line, and date it in the appropriate space to the left. If there are two petitioners, both petitioners must sign and date the form.

Review the completed form for accuracy prior to filing it with the court. If completing this form on-line, some fields may be filled in automatically based on entries in other fields. If more space is needed for any question, please attach additional sheets of paper.

NHJB-2165-P Instructions (12/01/2008)

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