Fillable Mpc320 Verified Motion For Appt Temp Guardian For Incapacitated Person Fill (Commonwealth of Massachusetts)

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Mpc320 Verified Motion For Appt Temp Guardian For Incapacitated Person Fill (Commonwealth of Massachusetts)

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BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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MPC 320 (5/30/11) MVER
of
page
The within Motion hereby is
ALLOWED (see Order Appointing Temporary Guardian).
DENIED.
JUSTICE OF THE PROBATE AND FAMILY COURT
Date
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court
Docket No.
Alleged Incapacitated Person/Respondent
on Petition filed
In the Interests of:
Last Name
First Name
Middle Name
Division
The court shall encourage the development of maximum self-reliance and independence of the Incapacitated
Person and make appointive and other orders only to the extent necessitated by the Incapacitated Person's
limitations or other conditions warranting the guardianship.
Now comes the moving party
First Name
Last Name
M.I.
who states as follows:
An emergency exists requiring the appointment of a Temporary Guardian as any delay in the appointment will cause
immediate and substantial harm to the health, safety or welfare of the Respondent, and no other person has authority to
act in the circumstances.
1.
The nature of the circumstances requiring the appointment of a Temporary Guardian are:
2.
The particular harm sought to be avoided is:
3.
The actions which need to be taken by a Temporary Guardian to avoid the harm are:
4.
Respondent:
Does (See Petition)
does not
Uncertain.
have a Health Care Agent in the Commonwealth or elsewhere or
attached
unavailable.
already filed with the Court
A copy of the Health Care Proxy is
5.
MPC 320 (5/30/11) MVER
of
page
Respondent:
Does (See Petition)
does not
Uncertain.
have a Durable Power of Attorney/Agent in the Commonwealth or elsewhere or
attached
unavailable.
already filed with the Court
A copy of the Durable Power of Attorney is
6.
WHEREFORE, PETITIONER REQUESTS THAT THIS HONORABLE COURT:
Appoint
The Petitioner(s)
or
Last Name
M.I.
First Name
or
Some suitable person.
as Temporary Guardian(s) of the Respondent to serve sureties for the following reasons:
with
without
The moving party further seeks specific court authorization:
to admit Respondent to a nursing facility;
to treat Respondent with antipsychotic medication in accordance with a treatment plan;
for the following treatment or action for which a substituted judgment determination may
be required:
to revoke the Health Care Proxy of the Incapacitated Person;
to apply for health insurance benefits including MassHealth on behalf of the Respondent.
In addition, I request that the Court:
SIGNED UNDER THE PENALTIES OF PERJURY
I affirm or swear under oath that I have read the foregoing Motion and that the statements set forth therein are true
and correct to the best of my knowledge.
Date
Signature of Moving Party
Date
Signature of Attorney for Moving Party
(Print name)
B.B.O. #
(Address)
(Apt, Unit, No. etc.)
(City/Town)
(State)
(Zip)
Primary Phone #:
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Mpc320 Verified Motion For Appt Temp Guardian For Incapacitated Person Fill (Commonwealth of Massachusetts)

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Completed 26 July 2020

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