Fillable LIST OF INTERESTED PERSONS (Vermont Judiciary)

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LIST OF INTERESTED PERSONS (Vermont Judiciary)

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PG73 – List of Interested Persons (09/2014) Page 1 of 2
STATE OF VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No.:
In re Guardianship of :
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.
Respondent
Name
Address
E-Mail Address (if known)
Telephone Number
Proposed
Guardian
Name
Address
E-Mail Address (if known)
Telephone Number
OTHER INTERESTED PERSONS
Name
Relationship to/ Interest in Respondent
Address
E-Mail Address (if known)
Telephone Number
Name
Relationship to/ Interest in Respondent
Address
E-Mail Address (if known)
Telephone Number
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.
Date
Petitioner’s Signature
Subscribed and sworn before me, this _________day of_______________________
Notary Public
List of Interested Persons Sheet 1_ of ____.
PG73 – List of Interested Persons (09/2014) Page 2 of 2
ADDITIONAL SHEET – if required (List of Interested Persons)
Name
Relationship to/ Interest in Respondent
Address
E-Mail Address (if known)
Telephone Number
Name
Relationship to/ Interest in Respondent
Address
E-Mail Address (if known)
Telephone Number
Name
Relationship to/ Interest in Respondent
Address
E-Mail Address (if known)
Telephone Number
Name
Relationship to/ Interest in Respondent
Address
E-Mail Address (if known)
Telephone Number
Name
Relationship to/ Interest in Respondent
Address
E-Mail Address (if known)
Telephone Number
Name
Relationship to/ Interest in Respondent
Address
E-Mail Address (if known)
Telephone Number
Name
Relationship to/ Interest in Respondent
Address
E-Mail Address (if known)
Telephone Number
Name
Relationship to/ Interest in Respondent
Address
E-Mail Address (if known)
Telephone Number
List of Interested Persons Sheet of ____.
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LIST OF INTERESTED PERSONS (Vermont Judiciary)

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Completed 30 July 2020

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