Free NHJB-2168-P - New Hampshire

Instructions

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THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us

Court Name: Case Name: Case Number:
(if known)

Guardianship of

REQUEST FOR WAIVER OF PERSONAL APPEARANCE;
WRITTEN STATEMENT (RSA 464-A:8, II) I/We, , represent that the , does not express a proposed ward, desire to attend the hearing concerning the finding of incapacity and appointment of a guardian of the person and estate, or the person, or estate. I/We certify that a copy of this document has been provided to the parties who have filed an appearance for this case or who are otherwise interested parties.
Date Petitioner(s) or Counsel for the proposed ward

PHYSICIAN'S AFFIDAVIT (RSA 464-A:8,II) I, 1. I am a medical physician at located at 2. The proposed ward, patient at 3. In my opinion, the proposed ward should be excused from attending the hearing concerning the finding of incapacity and appointment of a guardian of the person and estate, or the person, or estate, because: his/her overall physical, emotional or psychological condition is such that he/she is likely to suffer harm if required to attend; and/or he/she has no ability to understand the nature and consequences of the proceedings.
Date Physician Signature (must be in presence of notarial officer)

, M.D., under oath, hereby depose and say: , . , is a .

State of This instrument was acknowledged before me on

, County of by
Date Physician

My Commission Expires Affix Seal, if any

Signature of Notarial Officer / Title

ORDER
REQUEST FOR WAIVER OF PERSONAL APPEARANCE IS:
Date
NHJB-2168-P (06/04/2008) (formerly AOC-218-003)

GRANTED

DENIED

Judge
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