MODEL FORM FOR USE IN PETITION TO DETERMINE INCAPACITY PURSUANT TO FLORIDA PROBATE RULE 5.550
In the Circuit Court of the
_______________________Judicial Circuit,
in and for_______________________
County, Florida
Probate Division
Case No._______________________
In Re: Guardianship of
_______________________
Respondent's Name
An Alleged Incapacitated Person
_______________________
PETITION TO DETERMINE INCAPACITY
Petitioner, .....(name of petitioner)....., files this petition seeking a determination of incapacity of the respondent and states:
Petitioner's home address and mailing address:__________________________________________
__________________________________________________________
Petitioner's relationship to the respondent: ______________________________________________
______________________________________________________________________________
Respondent's home address, mailing address, county of residence:_________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Primary language of the respondent:__________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
( ) a. to marry. If the right to enter into a contract has been removed, the right to marry is subject to court approval;
( ) b. to vote;
( ) c. to personally apply for government benefits;
( ) d. to have a driver license;
( ) e. to travel; and
( ) f. to seek or retain employment.
Indicate which rights that the petitioner requests be removed from the respondent, but may be delegated to the guardian:
( ) a. to contract;
( ) b. to sue and defend lawsuits;
( ) c. to apply for government benefits;
( ) d. to manage property or to make any gift or disposition of property;
( ) e. to determine his or her residence;
( ) f. to consent to medical and mental health treatment; and
( ) g. to make decisions about his or her social environment or other social aspects of his or her life.
If all of the above are checked a determination of plenary incapacity is requested. If only some of the above are checked a determination of limited incapacity is requested.
Check any possible alternatives to guardianship:
( ) a. trust agreements;
( ) b. powers of attorney;
( ) c. designations of health care surrogates;
( ) d. other advance directives; or
( ) e. other_________________
If a guardianship is being sought, explain why the checked possible alternatives to guardianship are insufficient to meet the needs of the respondent:______________________________________
___________________________________________
Name | Address | Relationship |
WHEREFORE, this court is respectfully requested to determine incapacity of the respondent, award attorney's fees and costs pursuant to Chapter 744, Florida Statutes, and grant such other relief as the court deems just and proper.
Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief.
Signed on .....(date)......
___________________________
Petitioner's Signature
Petitioner's Printed Name:_______
___________________________
Petitioner's Address:___________
___________________________
Petitioner's Phone Number:___
Petitioner's E-mail Address:____
Fl. Prob. R. 5.901