______County,
Tennessee / PETITION FOR A CONSERVATORSHIP / Case Number
IN THE MATTER OF ______, RESPONDENT
Petitioner would show to the Court the following:
1. The name, date of birth, residence and mailing address of the Respondent are as follows:
2. The nature of the alleged disability of the Respondent is as follows:
3. The name, age, residence, and mailing address of the Petitioner and the relationship of the Petitioner to the Respondent are as follows:
4. The name, age, mailing address, and relationship of the proposed Conservator are as follows:
5. The name, mailing address, and relationship of the closest relative or relatives of the Respondent are as follows:
6. The name and mailing address of the person or institution, if any, having care and custody of the Respondent, or with whom the Respondent is living, are as follows:
7. The facts supporting the Petitioner's allegation that a conservator is needed are as follows:
8. Attached to this Petition is a sworn medical examination report or a statement that the Respondent has been examined. The sworn medical examination report has not been received but will be filed before the hearing.
9. The rights to be removed from the Respondent and transferred to the conservator are to [specify which]
q manage property and act as guardian of property q make health care decisions and act as guardian of the person q both
10. Financial information about the Respondent is not fully known to the Petitioner at this time. Petitioner requests that the Court enter an order authorizing Petitioner to investigate Respondent’s property in order to compile a list of property, income and expenses, as well as a proposed plan of management by the proposed Conservator.
REQUESTS FOR RELIEF
Petitioner prays:
1. That the Court appoint the individual or institution named above as Conservator of the person, property, or both (as specified above) of the Respondent.
2. That notice be served on the Respondent and the other interested parties.
3. That the Court appoint a guardian ad litem to represent the best interest of the Respondent in this proceeding.
4. That the Court set a time and place for the hearing of this cause.
5. For other, further and general relief.
Petitioner
STATE OF TENNESSEE
COUNTY OF ______
Personally appeared before me, the undersigned, a notary public in and for this county and state, the person named above with whom I am personally acquainted (or who proved his or her identity to me on the basis of satisfactory evidence) and who acknowledged that he or she executed this instrument for the purposes contained in it.
Witness my hand and official seal this day of ______, 20___.
Notary Public
My commission expires:
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