PG73 – List of Interested Persons (09/2014) Page 1 of 2
LIST OF INTERESTED PERSONS
Under 14 V.S.A. 3061(5), an interested person in an adult guardianship proceeding is a responsible adult who has a
direct interest in a person in need of guardianship and includes: the person in need of guardianship (the respondent);
the spouse of the respondent; the parents of the respondent; the adult children of the respondent; a proposed
guardian; an agent for the respondent named in a power of attorney and/or advance directive; a person nominated as
guardian in an advance directive. For each person listed, specify the person’s relationship to or interest in the
Respondent.
E-Mail Address (if known)
E-Mail Address (if known)
Relationship to/ Interest in Respondent
E-Mail Address (if known)
Relationship to/ Interest in Respondent
E-Mail Address (if known)
I declare that the list of persons above (with additional sheets, if any, attached) is complete and accurate
to the best of my knowledge, information, and belief, after diligent inquiry.
Subscribed and sworn before me, this _________day of_______________________
List of Interested Persons Sheet 1_ of ____.