MAIN STREET LEGAL SERVICES, INC.
Elder Law Clinic (718) 340-4300 Tel 2 Court Square
INSTRUCTIONS AND SAMPLE FORMS FOR INDIVIDUALS
SEEKING GUARDIANSHIP WITHOUT AN ATTORNEY
This instructional packet was created to assist individuals, who cannot afford an attorney,
with guardianship proceedings. Because guardianship proceedings are very serious, can deprive
a person of many rights, and are complex, we recommend that all individuals who can hire an
attorney!
If you cannot hire an attorney, and must start a guardianship proceeding, this packet is
designed to make that process as easy and understandable as possible. For further assistance, we
have included contact information and website links to other guardianship resources.
In addition to the instructions and sample forms, please use the checklist below to ensure
that no step is missed. For questions and referrals regarding guardianship, you can call the Elder
Law Clinic at Main Street Legal Services (contact information is listed above).
Good Luck!
Sincerely,
Elder Law Clinic
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernadette O’Donell(2010),FrancesFebres(2011),ReneeMurdock(2011),andCarlosSantiago(2011).
GUIDE TO BECOMING A GUARDIAN WITHOUT
A LAWYER
!
TABLE OF CONTENTS
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Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
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Page 4 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
GETTING STARTED
Before You Apply For A Guardianship…Look For Alternatives!
• In some cases, a person who has already executed, or has the mental capacity to execute, a power
of attorney, living will, health care proxy, and/or representative payee arrangement with social
security may not need a guardian. For descriptions about these additional alternatives, see the
Do-It-Yourself (DIY) Guardianship website available from the CUNY School of Law homepage.
Please refer to the end of this guide to see a list of alternatives that may be explored before
beginning the guardianship process.
You Can Apply For A Guardianship Without An Attorney!
• However, it is STRONGLY RECOMMENDED that you seek out the services of an attorney if
you can afford it. This guide should be used by people who cannot hire an attorney. The
guardianship process is different for every state. Below is information specific to people trying
to be a guardian in the state of New York.
How To Use This Guide:
1. Carefully read this guide. It will give you detailed instructions on how to become a guardian.
2. Review the forms attached to this guide. These forms include instructions on how to become a
guardian.
3. Fill out the forms attached to this guide
4. Submit the completed forms to the court.
5. Make sure that you have answered “YES” to all questions on the Checklist for Guardianship
Petitioners
.
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Page 5 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
What Is An Article 81 Guardianship Proceeding?
Generally
DEFINITION:
A guardianship proceeding is a legal action brought by someone (petitioner) who believes that
another person cannot take care of her/his own personal needs, e.g. healthcare. Or, the petitioner
believes that the person cannot manage her/his property, e.g. pay bills. In some cases, a
petitioner believes that a person cannot manage both personal needs and property management.
The petitioner believes that because of this person’s inability, the court should appoint someone
to have the powers to make decisions about personal needs or financial management on behalf of
that person. For the purpose of these types of hearings, the person who might need a guardian is
called either an Alleged Incapacitated Person (AIP) or a Person In Need of a Guardian (PING).
PROVING YOUR CASE:
You must show by clear and convincing evidence, i.e. that the evidence is highly or substantially
probable to be true than not true, that the person is likely to suffer harm because:
o The appointment of a guardian is necessary
o s/he cannot manage her/his property and / or provide for her/his personal needs and
o s/he cannot understand and appreciate the nature and consequences of not being able to
care for her/his own property, and or, own personal needs.
SCOPE OF POWERS:
If this legal action is successful, a guardian will be appointed by the court to make certain
decisions on behalf of the person. Because the court tries to respect and promote the rights of the
person who needs a guardian, the powers of a guardian are limited to those that are the “least
restrictive.”
POWERS:
The powers of a guardian are separated into two different areas: 1) property management; and 2)
personal needs. A guardian’s powers might be limited to just one of these categories, but often a
guardian’s powers include both. If you are the one petitioning for guardianship, you can pick
and choose which powers you want to ask for.
o Property management may include, but is not limited to, the power to pay bills, authorize
the release of confidential records, make gifts, enter into contracts, marshal assets, create
trusts, pay for funeral expenses, and apply for government and private benefits.
o Personal needs may include, but are not limited to, the power to manage what kind of
medical treatment the person should receive, determine where the person should live,
decide the social activities of the person, determine if the person should travel, make
decisions regarding education, and apply for government and private benefits.
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Page 6 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
Who Can Apply To Be A Guardian?
• Any interested person over 18 may petition the court to become a guardian. This includes a
spouse, family members, someone who lives in the home of the person who may be in need, and
any other person or organization who is concerned about the person’s well-being.
The Responsibilities Of A Guardian
• According to Article 81 of the Mental Hygiene Law, a guardian has many legal responsibilities.
A guardian must personally visit the person at least four (4) times a year.
A guardian must also send reports to the court.
These reports must describe how the person is doing. The first report is due 90
days after the guardian officially qualifies as guardian. The next reports are due
once every year in May.
The law states that a guardian must handle this responsibility by always making decisions
for the person as if the person was making those decisions on her/his own with her/his
best interest in mind. Below, is a diagram of the powers, tasks, and ethical
responsibilities of a guardian.
Diagram Of The Powers, Tasks, And Ethical Responsibilities Of A Guardian
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Page 7 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
BEFORE THE HEARING
The Documents You Need to File For Guardianship:
1. Request for Judicial Intervention:
This form has to be filed for the court to take your case and assign it to a judge. See the attached
“Request for Judicial Intervention” instructions on how to fill out this form. Be sure to make a
copy of the RJI for the County Clerk’s office to have on file. A Request for Judicial Intervention
cost $95 and you must also pay $210 to get an Index Number. This number is what you and the
court system will use to track your case as it goes through the system. You can purchase the
index number by going to the
County C
lerk’s office of the courthouse where you will be filing.
The County Clerk’s office will want a copy of the verified petition for their records, so be sure to
bring a photocopy of your original petition for them to keep when you pay for the index number.
*Please Note: There may be a way to get this fee waived. A person petitioning for guardianship
may be able to file for a “
poor person’s” affidavit
to request a waiver of these fees. See the
attached “Poor Person’s Affidavit” for instructions on how to do this.
Also Note: The County Clerk’s office does not accept personal checks, and filing fees change
periodically. Check the New York Unified Court System or contact the
County Clerk
to find
and/or verify the current filing fee.
2. Order to Show Cause:
Explains legal rights, along with date, time, and place of the hearing. It also describes the rights
afforded to the incapacitated person, and it lists the same powers over the alleged incapacitated
person that you requested in your petition. Although the Order to Show Cause is signed by a
judge, it is your responsibility to write it and submit to the court for the judge’s approval. The
judge will then fill out the time, date, and place of the hearing. See the attached “Instruction
Sample Order to Show Cause” for the information necessary to put in the order to show cause.
3. Verified Petition:
Explains to the court why a guardian is necessary for the person and why you should be the
guardian. You must describe why the person needs a guardian and why you, or somebody else,
should be the guardian. It also lists the specific powers you think the guardian needs. The
petition gives you the opportunity to tell the judge your story, so be as specific as possible when
describing why the person needs a guardian.
Read and fill out the attached “Petition Form” for the information necessary to put in the
Verified Petition.
Sign the petition and verification in front of a notary public. A notary public can often be
found at banks or in offices near courthouses.
4. Notice of Proceeding:
This form is mailed together with the signed Order to Show Cause to interested parties. See the
attached “Sample Notice of Proceeding” for the information that’s necessary to put in the notice
of proceeding.
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Page 8 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
Where And How To File?
Bring the RJI, Verified Petition and Order to Show Cause to the Guardianship Clerk,
have them file the papers (stamped filed), and purchase an Index Number.
! The Guardianship Clerk has an office in the Supreme Court building of every
county. Below is a list of where the Guardianship Clerks offices are in New York
City.
(List is current through December 13, 2011)
o Manhattan:
Scott Singer, Guardianship Clerk
60 Centre Street, Room 148
New York, NY 10451
(646) 386-3328
o Queens:
Charles Nocilla, Guardianship Clerk
88-11 Sutphin Boulevard, Room 100
Jamaica, NY 11435
(718) 298-1040
o Bronx:
Jose Pagan/ Laura Conaty, Guardianship Clerks
851 Grand Concourse, Room 6M-10
Bronx, NY 10451
(718) 618-1330
o Brooklyn:
Joseph Musolino, Guardianship Clerk
360 Adam Street, Room 850
Brooklyn, NY 11201
(347) 296-1757
o Staten Island:
Elyse VonEgloffstein, Guardianship Clerk, Trial Part 12
18 Richmond Terrace
Staten Island, NY 10301
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Page 9 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
After You Have Filed The Order To Show Cause And Verified Petition
You have to get a signed copy of the order to show cause. There may be a few ways to
get this copy. Call the clerk a few days after the hearing and see is the signed copy of the
Order to Show Cause is ready to be picked up. You may have to go to the court
personally to make a copy, or the secretary might be able to fax the order to show cause
to you.
! The Order to Show Cause will schedule a hearing date that is usually within 28
days from the date the Order to Show Cause was signed by the judge. The first
thing to do is, check that date and make sure you are available to come to court on
that day.
Once you have a copy of the order to show cause, you have to send copies of the order to
a few people. Below is a checklist detailing who you will have to send a signed copy of
the order to, by when, what other paperwork may be needed, and how you have to send
the copy.
! It is important to note, always read the order. The order may have a different list
from below or change the date in which the list of people should receive the
paperwork.
Who to Send the Order to Show Cause to and How
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Page 10 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
THE HEARING
Preparing for the hearing
• It is impossible to predict everything that might happen at the hearing. Each judge is different,
and each judge runs her courtroom differently. However, you can take the following steps to
prepare for the hearing.
Prepare what you are going to say. You will have to testify in court. Carefully review
your verified petition in order to ensure that the relief you request in your petition
matches what you will say in court.
! Tip: develop a clear and short story telling the judge why you should be a
guardian and why the alleged incapacitated person is in need of a guardian.
Practice what you are going to say before the hearing.
! Be prepared to describe the person’s daily routine, what services the person uses
or needs, and why she/he is no longer able to manage personal needs and/or
property.
Prepare and inform other witnesses. If there are other people who you think should
testify in court, such as family members, neighbors, people who care for the person, and
social workers, let them know of the hearing date and time.
During the hearing, ask questions! Remember, it’s okay to ask for the judge or attorney
questioning you for clarification when you don’t understand something. Everyone has a
right to be heard fairly and justly in a court of law, with or without an attorney.
At The Hearing
• Evidence will be presented to the judge regarding whether the person needs a guardian.
Questions or objections may be raised by any interested person, this includes you! The burden is
on you, the petitioner, to establish that the person really needs a guardian. Most often, the judge
will decide whether or not to appoint a guardian at the end of the hearing. Sometimes, the judge
will withhold the decision and mail it at a later date.
• At the end of the hearing, the judge will issue an order on the record stating his/her decision on
whether a guardian will be appointed, with which powers, for how long, etc.
o On the record means that everything stated in the hearing is being recorded either
electronically or typed up by the court reporter.
• At the end of the hearing, the judge will usually direct the petitioner to “settle” the order. See
below for a step-by-step guide to “settling” an order.
!
Page 11 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
WHAT TO DO AFTER THE HEARING
Settling the Order
1) What does it mean to “settle” the order?
Settling the order is when the parties come to an agreement on what should be written in the
order. This must be consistent with the judge’s oral ruling during the hearing. In this situation
the petitioner (you) is usually in charge of drafting the order.
2) How do you draft the order?
You must get the court transcript (record) from the court reporter. At the end of the hearing, you
will be given the court reporter’s contact information so that you can get a print copy of the
transcript. Once you receive the transcript, you will then refer to the portion of the hearing
where the judge orally makes his or her decision, and draft a
written order
consistent with the
judge’s oral ruling. See form
3) What has to be in a written order?
The order should describe in detail: the court’s findings with regard to the AIP’s condition, the
need for a guardian, the nature of guardianship, and any limitations on the guardian’s power(s).
4) What you do after you write the order?
You must then send it to the AIP, or if represented by a lawyer, the AIP’s lawyer so that they can
make any changes that they believe is consistent with the judge’s ruling. Once both parties agree
to the terms of the order, a copy, signed by both parties, is sent to the judge’s clerk for the judge
to modify and/or sign. Once the judge signs the order, it is “entered.” “Entered” refers to the
process of the order being filed with the County Clerk’s office.
5) What to do after the order is entered?
The petitioner must then send a Notice of Entry along with the final order, to all persons who
received a copy of the Verified Petition. A Notice of Entry simply informs everyone that the
order is final and has been signed and entered.
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Page 12 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
After the Order is Settled, Signed and Entered by the County Clerk
The Guardian Must:
Obtain a bond with a surety company, unless the judge has waived this requirement. This
applies in cases where the person who needs the guardian has a lot of money or property.
Sign an
Oath and Designation
form. This is where you swear to carry out the duties of a
guardian, and file it with the County Clerk. Prepare a Written Commission and submit
it to the County Clerk along with the Oath and Designation form. Within 5 days of the
County Clerk receiving the Oath and Designation form, they will sign and return it to
you. This is called the Written Commission, which is proof that you are lawfully
authorized to act within your designated power(s) on behalf of the incapacitated person.
Complete a guardianship-training course within 90 days of the appointment. The Office
of Administration periodically offers classes and provides a list of guardians who have
completed the course. The Guardianship Assistance Network (GAN) also provides
training programs and other resources for guardians.
File an Initial Report with the assigned court examiner. The initial report must include
proof that you have completed the training and have begun taking steps to fulfill your
duties to the incapacitated person. If you believe changes need to be made to the powers
authorized to you, then you must state that in the report and explain why. You should ask
the court examiner for help if any changes need to be made.
File an annual report in May. You must file an annual report in May about the previous
calendar year. For example, you report for the year of 2012 will be filed in May of 2013.
report similar to an initial report, every year. Sample annual reports can be found at the
Guardianship Assistance Network website, or at the New York City Civil Supreme Court
website.
! Remember: A guardian must keep careful and detailed records on all activity
regarding the incapacitated person.
! This includes, but is not limited to: receipts, bills, notes, medical records,
government benefit records, etc. This documentation must be included with the
annual report.
*See Checklist for Guardians below:
!
Page 13 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
CHECKLISTS FOR
GUARDIANSHIP PETITIONERS
Before the Hearing:
o Fill out the Verified Petition (and have it notarized)
o Fill out the Order to Show Cause
o Fill out the Request for Judicial Intervention (RJI)
o Take the Verified Petition, Order to Show Cause, and RJI to the Court and file the forms with
the court clerk and receive an index number
o Wait a few days for the judge to sign the Order to Show Cause
o Personally deliver the signed Order to Show Cause and the Verified Petition to the person who
needs a guardian (the AIP or PING) and his or her lawyer, if applicable
o Send (via mail or fax) the Order to Show Cause and Verified Petition to the Court Evaluator
o Fill out the Notice of Proceeding and send the signed Order to Show Cause and the Notice of
Proceeding to all interested parties (family, friends, etc.)
o Prepare for the hearing: have a statement to say to the judge, have all documents in order,
prepare witnesses (if applicable)
o Go to the hearing
!
Page 14 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
AFTER THE HEARING
(If the judge appoints you as guardian)
o Prepare an Order form (ask the Judge if he or she has an Order form to fill out)
o Fill out the Notice of Settlement. The “return date” on the Notice of Settlement should be 15
days from the day you mail it.
o Mail the Order and Notice of Settlement to all interested parties
o File the Order and Notice of Settlement, along with an Affidavit of Service, with the court
clerk
o Wait a few days for the judge to sign the Order and then pick up the Order from the Court
o Mail the signed Order to all interested parties
o Fill out the Oath and Designation (and have it notarized)
o Fill out the Commission
o File the Oath and Designation and Commission with the court clerk.
o Complete a guardianship training course
o File an Initial Report with the Court Examiner
* Must be completed within three business days, ** Must be completed ASAP, with at least 2 weeks
time before the hearing
!
Page 15 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
ALTERNATIVES TO GUARDIANSHIP
POWER OF ATTORNEY
• When you give someone power of attorney, that person acts as your agent and will have the
authority to spend your money and sell or dispose of your property during your lifetime without
needing your consent or having to tell you. However, in exercising this authority, your agent
must act according to the instructions you have provided. Where there are no specific
instructions, they are required to act consistently with your best interests.
• Your agent may be given the authority to make gifts in excess of $500.00 a year. Such actions
can significantly reduce your property or change how your property is distributed at your death.
Similarly, the gifts made by your agent must be consistent with any instructions you have
provided or otherwise be in your best interests. For your agent to make gifts to himself or
herself, you must separately grant that authority.
• You can request information from your agent at any time. At any time and for any reason, you
can appoint a different individual as your agent or terminate your power of attorney altogether,
so long as you are of sound mind. If you are no longer of sound mind, a court can remove your
power of attorney if she or she is acting improperly.
• Your agent cannot make health care decisions for you. Instead, you can establish a health care
proxy to make health care decisions for you.
*For more information regarding power of attorneys, please go to:
New York General Obligations Law, Article 15, Title 15 which is available at a law library or online
through the New York State Senate or Assembly websites:
www.senate.state.ny.us or www.senate.state.ny.us
HEALTH CARE PROXIES
• Health care proxies are agents that are appointed and granted the authority to make decisions
about medical treatment for a person whose doctor declares is unable to make their own health
care decisions. In order to give legal decision making authority to a family member or friend, an
agent should be appointed as a health care proxy. If no one is available or suitable to serve as an
agent, a living will can provide clear and convincing evidence of a person’s wishes, morals, and
religious beliefs regarding medical treatment.
• Appointing an agent as a health care proxy is the most effective way of maintaining control over
decisions concerning medical treatment, visitation, and access to medical records. You do not
need a lawyer to appoint someone as your health care proxy. Rather, you just need two adult
witnesses, other than your proposed health care agent.
*For more information and to get a health care proxy form, please visit the New York State
Department of Health Website, or click “here”.
*You can also get a Health Care Proxy Form and a Living Will at the New York State Bar Association
website, or click “here”.
!
Page 16 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
ASSISTED OUT-PATIENT TREATMENT
• Assisted Out-Patient Treatment (AOT) is available for individuals who have a mental disorder
and cannot live in the community independently without being a danger to themselves or others.
Therefore, AOT allows individuals and institutions (such as hospitals) to petition the court for
AOT services for the mentally disabled person in need of rehabilitation. The goal of the AOT
Program is to enable individuals with mental disorders to live safely in the community, avoid
repeated inpatient hospitalizations, and ensure they have access to comprehensive outpatient
services.
• A person may be ordered to receive Assisted Outpatient Treatment (AOT) if a court finds that he
or she:
o is at least 18 years of age and suffers from a mental illness and
o is unlikely to survive in the community without supervision based on a clinical
determination and
o has a history of non-compliance with treatment for mental illness which has led to 2
hospitalizations for mental illness in the preceding 3 years or resulted in at least 1 act of
violence toward self or others, or threats of serious physical harm to self or others, within
the preceding 4 years (time period may be extended in the event of current or recent
hospitalizations) and
o is, as a result of his or her mental illness, unlikely to voluntarily participate in outpatient
treatment that would enable him or her to live safely in the community and
o based on treatment history and current behavior, is in need of outpatient treatment to
prevent a relapse or deterioration likely to result in serious harm to self or others and
o will likely benefit from Assisted Outpatient Treatment.
• Authorized petitioners for AOT include:
o any person 18 years of age or older with whom the subject resides;
o the parent, spouse, adult sibling, or adult child of the subject;
o the director of a hospital in which the subject is hospitalized;
o the director of any public or charitable organization, agency or home providing mental
health services to the subject or in whose institution the subject resides;
o a qualified psychiatrist who is either supervising the treatment of or treating the subject
for a mental illness;
o a licensed psychologist or a licensed social worker who is treating the subject of a mental
illness;
o the director of community services, or his or her designee, or the social services official
of the city or county in which the subject is present;
o a parole or probation officer assigned to supervise the subject.
*For more information, go to the NY State Department of Mental Health or click “here.”
!
Page 17 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
REPRESENTATIVE PAYEE
• When an individual who receives Social Security or Supplemental Security Payments cannot
manage their benefits by themselves, Social Security will allow a family member, friend or
qualified organization, to receive those benefits on behalf of the individual. This person is
known as a “Representative Repayee” and must use the benefits to pay for the individual’s
current and/or reasonably-known future needs. Representative Repayees must keep careful
records of their use of the individual’s benefits and must complete an annual accounting which
can be done online at: http://www.ssa.gov/payee/form/index.htm. For more information about
Representative Repayees, please go to the Social Security Administrative website:
http://www.ssa.gov/payee/.
• Or, contact:
o By Mail:
Social Security Administration Office of Public Inquiries Windsor Park Building 6401
Security Blvd. Baltimore, MD 21235
o By Telephone:1-800-772-1213
SUPPLEMENTAL NEEDS TRUST
• A supplemental needs trust (SNT) is a trust established to allow people to have excess income
and still be eligible to receive government benefits. For example, if a person is currently
receiving Medicaid and/or needs Medicaid to receive a home health care aid, they can still be
eligible so long as their excess income goes into the SNT. There are different types of SNTs.
Some SNTs allow you to put your own funds into a trust while other trusts are established using
the funds of someone else.
• To establish a SNT with your own money, there are two types to consider:
o Individual trusts and Pooled Trusts.
• With individual trusts, any money left over after the person passes is used to pay back Medicaid,
and if there is still money leftover, it then goes to the individual’s estate. With pooled trusts, any
money left over in the trust goes to the non-profit organization that administers the trust, for the
benefit of other individuals.
• To qualify for an Individual SNT, an individual must:
o Be under the age of 65; and
o Have a severe and persistent disability (recognized by the state). *If you receive Social
Security Disability payments then you will automatically be recognized by the State as
having a severe and persistent disability
!
Page 18 of 37
Created by: Main Street Legal Services, Elder Law Clinic Interns of CUNY School of Law:
Bernice O’Donell (2010), Frances Febres (2011), Renee Murdock (2011), and Carlos Santiago (2011).
• There are limitations on what an individual SNT can pay for. Depending on which government
benefit(s) a person receives or hopes to receive, determines which limitations will be placed on
their SNT. For example, a person who receives Supplemental Security Income cannot use the
SNT to pay for any expenses relating to shelter (such as rent or a mortgage) or food, but can use
the SNT funds on almost anything else.
• For Pooled Trusts, the SNT can pay for most expenses, such as rent, utilities, and credit card
bills. However, it is the non-profit organization that administers the trust that pays these expenses
for the individual. The individual cannot access the money in the trust directly.
• To qualify for an pooled SNT, an individual:
o Can be ANY age; and
o Have a severe and persistent disability (recognized by the state). *If you receive Social
Security Disability payments then you will automatically be recognized by the State as
having a severe and persistent disability
At an I.A.S., Part _____ of the Supreme
Court of the State of New York, County
of New York at the Supreme Court
Building_____________________________________
________________________________
on the ______ day of ____________, 20___.
PRESENT:
HONORABLE _________________________
JUSTICE
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF ___________________
------------------------------------------------------x
In the Matter of the Application of
_____________________
[Your Name] Petitioner,
ORDER TO SHOW CAUSE
For the Appointment of a Guardian Index No.: ______________
of the Personal Needs and
Property Management of
______________________,
[Name of Alleged Incapacitated Person (AIP)
or Person In Need of a Guardian (PING)]
An Alleged Incapacitated Person
Pursuant to Article 81
of the Mental Hygiene Law,
Respondent.
------------------------------------------------------x
IMPORTANT
AN APPLICATION HAS BEEN FILED IN COURT BY
___________________ WHO BELIEVES YOU MAY BE UNABLE TO
[Your Name]
TAKE CARE OF YOUR PERSONAL NEEDS OR FINANCIAL AFFAIRS.
_______________________ IS ASKING THAT ________________________
[Your Name] [Name of Proposed Guardian]
BE APPOINTED TO MAKE DECISIONS FOR YOU. WITH THIS PAPER
IS A COPY OF THE APPLICATION TO THE COURT SHOWING WHY
_________________________BELIEVES YOU MAY BE UNABLE TO TAKE
[Your Name]
CARE OF YOUR PERSONAL NEEDS OR FINANCIAL AFFAIRS.
BEFORE THE COURT MAKES THE APPOINTMENT OF SOMEONE TO
MAKE DECISIONS FOR YOU THE COURT HOLDS A HEARING AT
WHICH YOU ARE ENTITLED TO BE PRESENT AND TO TELL THE
JUDGE IF YOU DO NOT WANT ANYONE APPOINTED. THIS PAPER
TELLS YOU WHEN THE COURT HEARING WILL TAKE PLACE. IF
YOU DO NOT APPEAR IN COURT, YOUR RIGHTS MAY BE
SERIOUSLY AFFECTED.
YOU HAVE THE RIGHT TO DEMAND A TRIAL BY JURY. YOU
MUST TELL THE COURT IF YOU WISH TO HAVE A TRIAL BY JURY.
IF YOU DO NOT TELL THE COURT, THE HEARING WILL BE
CONDUCTED WITHOUT A JURY. THE NAME, ADDRESS, AND
TELEPHONE NUMBER OF THE CLERK OF THE COURT ARE:!
[Name of Clerk for your County]
[Address of Clerk for your County]
THE COURT HAS APPOINTED A COURT EVALUATOR TO
EXPLAIN THIS PROCEEDING TO YOU AND TO INVESTIGATE THE
CLAIMS MADE IN THE APPLICATION. THE COURT MAY GIVE THE
COURT EVALUATOR PERMISSION TO INSPECT YOUR MEDICAL,
PSYCHOLOGICAL OR PSYCHIATRIC RECORDS. YOU HAVE THE
RIGHT TO TELL THE JUDGE IF YOU DO NOT WANT THE COURT
EVALUATOR TO BE GIVEN THAT PERMISSION. THE COURT
EVALUATOR’S NAME, ADDRESS, AND TELEPHONE NUMBER ARE:
[The Court will fill in the name of the Court Evaluator here]
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
YOU ARE ENTITLED TO HAVE A LAWYER OF YOUR CHOICE
REPRESENT YOU. IF YOU WANT THE COURT TO APPOINT A LAWYER
TO HELP YOU AND REPRESENT YOU, THE COURT WILL APPOINT A
LAWYER FOR YOU. YOU WILL BE REQUIRED TO PAY THAT LAWYER
UNLESS YOU DO NOT HAVE THE MONEY TO DO SO.
You and any other party to this proceeding have the right to:
• Present evidence
• Call witnesses, including expert witnesses, and
• Cross-examine witnesses, even those witnesses called by the court
On reading and filing the annexed petition of _____________________, duly verified on
[Your Name]
______________________________, from which it appears that the Alleged Incapacitated
[Date you signed the Order to Show Cause]
Person or the Person in Need of a Guardian, above named, is physically present in New York
County, State of New York and that the appointment of a Guardian is necessary to provide for
the personal needs and to manage the property and financial affairs of that person; and that
person agrees to the appointment, or that the person is incapacitated as defined in subdivision (b)
of Section 81.02 of the Mental Hygiene Law; and it appearing that the Alleged Incapacitated
Person owns or possesses certain property within the State of New York.
LET _________________, the alleged incapacitated person or person in need of a
[Name of AIP or PING]
guardian, and those persons entitled to service pursuant to Mental Hygiene Law Section 81.07(e)
and the court evaluator, hereinafter named,
[The Court will fill in the appropriate names here]
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
SHOW CAUSE before me or the Justice presiding at I.A.S. Part ____ of this court, to be
held in the ____________ County Supreme Court, located at ___________________________
[Name of County] [Address of Court in Your County]
, on the ____ day of ____________, at ________ AM or PM of that day, or as soon
[Court will fill in the date and time that the hearing will take place]
thereafter as counsel can be heard,
WHY a Guardian should not be appointed for the Personal needs and Property
Management of __________________ an Alleged Incapacitated Person or Person in Need of a
[Name of AIP or PING]
Guardian , upon the Guardian qualifying in accordance with the statutes of the State of New
York in such cases made and provided; and
WHY a personal needs and property management guardian should not be authorized to exercise
the following powers on behalf of the Alleged Incapacitated Person or Person in Need of a Guardian if
the relief sought in the petition is granted:
PERSONAL NEEDS POWERS
If a Guardian is appointed for you, the Guardian may have the authority to exercise the following
powers over your person:
[List ONLY the personal activities that you think the AIP or PING cannot perform on his/her own]
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
__________________________________________
PROPERTY MANAGEMENT POWERS
If a Guardian is appointed for you, the Guardian may have the authority to exercise the following
powers over your property:
[List ONLY the property/ financial activities that you think the AIP cannot perform on his/her own]
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
________________________
SUFFICIENT REASON APPEARING THEREFOR:
ORDERED, that____________________________ of __________________________,
[Name of Court Evaluator] [Address of Court Evaluator]
New York is hereby appointed Court Evaluator herein to investigate the claims made in the
petition; to determine whether Counsel should be appointed by the Court; and report to the Court
the functional abilities and limitations of the Alleged Incapacitated Person in this proceeding;
and it is further
ORDERED, that ____________________________ of _________________________,
[Name of AIP’s Lawyer, if applicable] [Address of AIP or PING’s Lawyer, if applicable]
New York is hereby appointed Counsel to represent ________________________in this
[Name of AIP or PING]
proceeding, and it is further
ORDERED, that service pursuant to MHL § 81.07 (e)(2)(i) of a copy of this Order and of
the papers upon which it is granted upon _____________________ by personal delivery, on or
[Name of AIP or PING]
before the _______ Day of __________________, be deemed good and sufficient
[Day] [Month, Year]
service, and it is further
ORDERED, that this Order to Show Cause and the papers upon which it is based shall be
served personally, by overnight delivery or by fax, pursuant to MHL § 81.07 (e)(2)(ii) upon
_________________________, the Court Evaluator and __________________________, the
[Name of Court Evaluator] [Name of AIP or PING’s Lawyer, if applicable]
court appointed attorney on or before the ________ day of _________________shall be
[Day] [Month, Year]
deemed good and sufficient service; and it is further
ORDERED, that service by mail of the Order to Show Cause and Notice of Proceeding, pursuant
to MHL §81.07 (g)(2) upon the following:
[List All Interested Parties, other than the AIP or PING, the court evaluator, and the attorney for the
AIP or PING, if any]
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
________________________________________________
! ! ! ! ! ! ! E N T E R,
____________________________________
[Judge’s Signature] J.S.C.
!
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF ___________________
[Name of County]
____________________________________________X
In the Matter of the Application of:
Verified
Petition
_____________________________
[Your Name]
Petitioner Index No:
___________________
For the Appointment of a Guardian of the
Person and/or Property of
_____________________________
[Name of Alleged Incapacitated Person (AIP)]
Person Alleged to be Incapacitated
Respondent
_____________________________________________X
TO THE SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF _________________
The Petition of ______________________, as an interested party of the ALLEGED
[Your Name]
INCAPACITATED PERSON, _____________________, respectfully shows as follows.
[Name of AIP or PING]
1. The alleged incapacitated person is _________years old, and was born on
[Age of AIP or PING]
_______________________.
[AIP or PING’s Date of Birth]
2. S/he lives at _______________________________________________. His/her
[AIP or PING’s Address]
telephone number is ____________________________.
[AIP or PING’s Area Code and Home Telephone Number]
[If applicable add:]
___________________ is currently a patient at __________________________,
[Name of AIP or PING] [Name of Hospital or Facility]
located at _______________________________________, having been admitted
[Address of Hospital or Facility]
on or about ___________________. His/her room is located at ___________. Her
[Date of Admission] [Location of Room]
telephone number is ____________________________.
[Area Code and Telephone Number at Hospital or Facility]
3. Describe the marital status of AIP or PING, including spouse’s relationship to petitioner,
date of marriage, medical and mental status of spouse, and residence of spouse:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________
4. As described in this petition, ___________________ is incapacitated in that he/she is
[Name of AIP]
unable to provide for his/her personal needs and property management and cannot adequately
understand and appreciate the nature and consequences of such inability.
5. Describe with particularity the AIP’s current condition:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
_________
6. Describe with particularity items illustrating the AIP’s inability to function in a manner
necessary to prevent harm to himself or herself. (i.e. Describe the AIP’s inability in some of
the following areas: mobility, eating, toileting, dressing, grooming, housekeeping, cooking,
shopping, money management, banking, driving or using public transportation, and other
activities related to personal needs and to property management):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________
7. Because of his/her condition, ________________________ is unable to consistently
[Name of AIP]
provide for his/her own personal needs and is likely to suffer harm in the following areas:
[List area’s where AIP will suffer harm, for example, proper nutrition, health care and
hygiene, safety measure, and living environment]
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
_________________________________
8. ______________________ is likely to suffer harm because he/she cannot adequately
[Name of AIP]
understand and appreciate the nature and consequences of his/her inability to provide for
property management. The specific allegations that demonstrate that
_____________________ would suffer harm are as follows:
[Name of AIP]
[List with particularity AIP’s inability to handle various aspects of property management
including inability to protect assets and meet financial obligations. For example, inability to
attend to financial transactions, balance a checkbook, manage social security check, budget
and allocate resources.]
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________
9. In light of the medical conditions and functional limitations listed above, I believe that
______________________ is likely to suffer harm and that the least restrictive
[Name of AIP]
form of intervention is the appointment of a guardian of the person with the following
powers: [List personal needs powers being sought]
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________
10. In light of the medical conditions and functional limitations listed above, I believe that
______________________ is likely to suffer harm and that the least restrictive
[Name of AIP]
form of intervention is the appointment of a guardian of the property with the following
powers: [List property management powers being sought]
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________
11. I am asking the court that I be appointed guardian of the person and property of
______________________.
[Name of AIP]
WHEREFORE, your Petitioner respectfully requests that the Court:
1) Declare that ____________________is a person who is incapacitated, as that term is defined
in Section 81.02(b) of the Mental Hygiene Law;
2) Appoint a Court Evaluator for ______________________;
3) Appoint _________________ as Guardian; and
4) Grant such other further relief as this Court deems just and proper.
Dated: ___________________________
____________, New York
VERIFICATION
STATE OF NEW YORK )
ss.:
COUNTY OF _____________ )
____________________, being duly sworn, says that s/he is the petitioner in the above-named
[Your name]
proceeding and that the foregoing petition is true to his/her own knowledge except as to the matters
therein stated to be alleged information and belief and as to those matters s/he believes it to be true.
__________________________________________
Print Name
__________________________________________
Signature
Sworn to before me this ______ day of _______________
_________________________________________
NOTARY PUBLIC
!
!
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF ______________________
[Name of County]
----------------------------------------------------------X
In the Matter of the Application of
NOTICE OF PROCEEDING
_____________________________
[Your Name] Index No. _______________
Petitioner,
For the Appointment of a Guardian
for___________________________
[Name of Alleged Incapacitated Person (AIP)]
An Alleged Incapacitated Person.
------------------------------------------------------------X
NOTICE OF GUARDIANSHIP PROCEEDING
PLACE OF HEARING: Date & Time:______________________
Honorable________________________
Supreme Court _____________ County
_________________________________
[Address of Court In Your County]
_________________________________
[Address of Court In Your County]
NATURE OF PROCEEDING: Article 81 Guardianship Proceeding Seeking
the Appointment of a Personal Needs and
Property Management Guardian of
___________________________________
[Name of Alleged Incapacitated Person (AIP)]
AIP or PING’S NAME & ADDRESS: ___________________________________
___________________________________
___________________________________
NAMES & ADDRESSES OF OTHER
INTERESTED PARTIES:
Party 1:___________________________________
___________________________________
___________________________________
Party 2:____________________________________
____________________________________
____________________________________
Party 3:____________________________________
____________________________________
____________________________________
Party 4:____________________________________
____________________________________
____________________________________
Party 5:____________________________________
____________________________________
____________________________________
Party 6:____________________________________
____________________________________
____________________________________
PETITIONER’S ______________________________________
NAME AND ADDRESS: ______________________________________
_______________________________________
_______________________________________
DATED: ______________, New York
SIGNATURE: ______________________________________
[Your Signature]
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF ___________________
[Name of County]
____________________________________________X
In the Matter of the Application of:
NOTICE OF SETTLEMENT
_____________________________
[Your Name]
Petitioner Index No:
___________________
For the Appointment of a Guardian of the
Person and/or Property of
_____________________________
[Name of Alleged Incapacitated Person (AIP)]
Person in Need of a Guardian/ Incapacitated Person
Respondent
_____________________________________________X
PLEASE TAKE NOTICE that the Order and Judgment Appointing Guardian of which the within
is a true copy will be presented for settlement to the
HON. _________________________, one of the Judge of the within named Court as the
[Name of Judge]
Supreme Courthouse, located at _____________________________________________, IAS
[Address of Court in your county]
Part ______, on the __________________________.
[Part of Court] [Date of Hearing]
Dated:______________________________
From: ______________________________
[Your Name]
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF ___________________
[Name of County]
____________________________________________X
In the Matter of the Application of:
Oath and Designation
_____________________________
[Your Name]
Petitioner Index No:
___________________
For the Appointment of a Guardian of the
Person and/or Property of
_____________________________
[Name of Alleged Incapacitated Person (AIP)]
An Incapacitated Person
Pursuant to Article 81
Of the Mental Hygiene Law,
Respondent
______________________________________________X
TO THE SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF _________________
[County]
___________________________, being duly sworn, deposes and says:
[Your name]
1. OATH OF GUARDIAN: I am a citizen of the United States, and I am over the age of
eighteen years. I will well, faithfully and honestly discharge the trust reposed in me as a
guardian for ______________________, an incapacitated person. I will obey all lawful
[Name of Incapacitated Person]
directions of any court of competent jurisdiction, and I will render a just and true account
of all moneys and other property received by me and of my application of the same
whenever required to do so by a court of competent jurisdiction pursuant to the
aforementioned Order of this court.
2. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I have been appointed
guardian for ________________________ of _________________, New York, an
[Name of Incapacitated Person] [County]
incapacitated person, and I do hereby designate the Clerk of the Supreme Court,
_______________ County and his or her successor in office, as the person on whom
[County]
service of any process issuing from said court in this proceeding, or in any other
proceeding, which shall affect the estate of _________________________, may be made
[Name of Incapacitated Person]
in like manner and with like effect as if it were served personally upon me whenever I
cannot be found and served within the State of New York after due diligence is used. I
further advise the said clerk that I am a resident of the State of New York and maintain
my home at _______________________________, as appears in the Court Order
[Your Address]
appointing me guardian.
DATED: _______________, New York
[County]
_______________
[Day Month, Year]
_______________________________
Signature
_______________________________
[Print Name of Guardian]
On the _________ day of _______________________, in the year ______________,
[Day] [Month] [Year]
before me, the undersigned, a Notary Public in and for said State, personally appeared
________________________, personally known to me or proved to me on the basis of
[Your Name]
satisfactory evidence to be the individual(s) whose name(s) is subscribed to the within
instrument and acknowledged to me that he/she/their signature(s) on the instrument, the
individual(s), or the person upon behalf of whom the individual(s) acted, executed the
instrument.
__________________________________
NOTARY PUBLIC
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF ___________________
[Name of County]
____________________________________________X
In the Matter of the Application of:
COMMISSION
_____________________________
[Your Name]
Petitioner Index No:
___________________
For the Appointment of a Guardian of the
Person and/or Property of
_____________________________
[Name of Alleged Incapacitated Person (AIP)]
Person in Need of a Guardian/ Incapacitated Person
Respondent
_____________________________________________X
!
THE PEOPLE OF THE STATE OF NEW YORK,
TO ALL TO WHOM THESE PRESENTS SHALL COME:
GREETINGS:
WHEREAS, by Order duly made on ________________, and entered in the Office of the
[Date of Order]
Clerk of the County of _____________ on _________________________, in a proceeding in the
[Your County] [Date on Order]
Supreme Court entitled, "In the Matter of the Application of _________________________,
[Your Name]
Petitioner, for the appointment of a Guardian of _________________________, an Alleged
[Name of Incapacitated Person or PING]
Incapacitated Person" it was found that the said __________________________was duly
[Name of Incapacitated Person or PING]
adjudged to be an incapacitated person on ________________________, and an order having
[Date of Decision]
been signed by the Honorable _______________________on _____________________; and
[Name of Judge] [Date of Order]
WHEREAS, _________________________, __________________________________,
[Your Name] [Your Address]
was appointed guardian by said Order and was directed to file in the clerk's office of the County of
___________________ a bond for the security required by law in the sum of $____________
[Your County] [Amount of Bond]
and on condition that said guardian will in all things faithfully discharge the duties and obey all lawful
directions of any court officer of competent jurisdiction pertaining to said trust and render a just and true
account of all moneys received and disbursed whenever required to do so by a court of competent
jurisdiction; and
WHEREAS, the authority of the guardian shall extend to all of the property of the incapacitated
person, both real and personal; and
WHEREAS, the bond has been duly executed and filed with the Clerk of this County; and
WHEREAS, the designation of the clerk of this court has been duly executed and filed in his or
her office;
NOW, THEREFORE, KNOW YE, that we have granted, given and committed, and by these
presents do give, grant and commit unto the said guardian, the possession, care and management of the
estate, real as well as personal, of said incapacitated person;
AND, the Guardian of the Property may, without prior authorization of the court, make
reasonable expenditures for the purpose of preserving the property of the incapacitated person;
AND, pursuant to Section 81.20 of the Mental Hygiene Law, the guardian shall:
(a) exercise only those powers that the guardian is authorized to exercise by order of the court;
(b) exercise utmost care and diligence when acting on behalf of the incapacitated person;
(c) exhibit the utmost degree of trust, loyalty and fidelity in relation to the incapacitated person;
(d) visit the incapacitated person not less than four times per year;
(e) afford the incapacitated person the greatest amount of independence and self-determination with
respect to property management and personal needs in light of that person's functional level,
understanding and appreciation of [his or her] functional limitations, and personal wishes,
preferences and desires with regard to managing the activities of daily living;
AND, pursuant to Section 81.20 of the Mental Hygiene Law, the guardian shall:
(a) preserve, protect and account for the incapacitated person's property and financial resources
faithfully;
(b) at the termination of the appointment, deliver the property to the person legally entitled to it; and
(c) perform all other duties required by law;
AND, pursuant to Sections 81.21 and 81.22 of the Mental Hygiene Law, the guardian shall:
(a) determine who shall provide personal care or assistance;
(b) make decisions regarding social environment and other social aspects of life;
(c) apply for government and private benefits, including Medicaid;
(d) consent to or refuse generally accepted routine or major medical or dental treatment;
(e) choose place of abode;
(f) authorize access to or release of confidential records;
(g) marshal income and assets;
(h) manage income and assets, including paying bills and monthly expenses;
(i) enter into contracts;
(j) defend or maintain any civil judicial proceedings;
(k) retain counsel, subject to court approval of fees;
(l) retain accountants, investment counsel and similar professionals and pay same;
(m) sign tax returns and deal with all federal, state and local tax authorities on all claims litigation,
settlement and other matters; and
(n) provide _______________________ with spending money;
[Name of IP or PING]
AND, the duration of the appointment of the guardian is indefinite;
AND, upon the death of the incapacitated person, the guardian shall have the authority to pay for
the reasonable funeral expenses of the incapacitated person;
AND, upon the death of the incapacitated person, the guardian shall have authority to pay the
bills of the incapacitated person which were incurred prior to the death of the incapacitated person,
provided the guardian would otherwise have had the authority to pay such bills;
AND, all persons are hereby directed and commanded to deliver to the guardian, upon demand
and presentation of a certified copy of the commission, the property of the incapacitated person of every
kind and nature which may be in their possession or under their control.
WITNESS, the Honorable ___________________________, one of the Justices of the
[Name of Judge]
Supreme Court of the State of New York, at the Courthouse, in the County of ___________________,
this ________________________________.
[Your County] [Today’s Date]
BY THE COURT
_______________________________
CLERK OF THE COURT
COUNTY OF ____________________
[Your County]
OTHER GUARDIANSHIP RESOURCES
OTHER FORMS
• Request for Judicial Intervention (RJI): F==OXii)))A,C-MB&=?AGMSiLM&>?i&g+iW*<61456L+##(_#%AO$L
• Application to Proceed as a Poor Person:
F==OXii)))A,C-MB&=?AGMSi-MB&=?i,C-i-+S+#iLM&>?iZMM&Z%&?M,?^%#+%LAO$L
OTHER RESOURCES
• New York State Bar Association (provides sample forms)
• Law help. org (This is the direct link to law help matters in New York specific to seniors. All
you have to do is enter your zip code)
• Guardianship Assistance Network (GAN) (provides training information and sample initial and
annual reports
• www.seniorlaw.com (award winning website with useful and accessible information)
• Comprehensive Manual prepared for the New York State Office of Children and Family
Services.
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