JV-069 (07/06/2015)
GUARDIAN AD LITEM MOTION FOR
ADDITIONAL HOURS/EXTENSION OF TIME
DOCKET NO.
Trial Court of Massachusetts
Juvenile Court Department
CASE NAME
APPOINTMENT DATE
NEXT COURT DATE
DIVISION
MOTION FOR ADDITIONAL HOURS/EXTENSION OF TIME TO FILE REPORT
(NAME)
I, , request:
Additional hours. No. of hours requested
(not to exceed 10 Hours):
No. of previously approved requests for additional hours:
Extension of time to file my report.
No. of previously approved requests for extension of time:
I am appointed as a Guardian Ad Litem for:
(check category of appointment)
Extraordinary Medical Treatment Legal Rights
A. Antipsychotic Medication Recommendation A. Privilege
B. Forgoing or Discontinuing Life Sustaining/Medical Treartment B. Claims
C. Administration of Medical Treatment and/or Procedure C. Advisor
Treatment Monitor Education Surrogate
Evaluator
(Issue): Diminished Capacity
REASON(S) FOR REQUEST
(MUST BE COMPLETED)
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NOTE: If additional space is needed, please fill out and attach a separate sheet.
TO BE COMPLETED BY COURT
DATE SIGNATURE OF JUSTICE
Motion is hereby allowed
Hours
(not to exceed 10 hours)
Motion is hereby denied
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Due Date
DATE SIGNATURE OF GUARDIAN AD LITEM