IN THE MATTER OF / §
§
§
§
§
§ / IN THE [PROBATE] [COUNTY] COURT
THE GUARDIANSHIP OF / [AT LAW] OF
AN ALLEGED INCAPACITATED PERSON / COUNTY, TEXAS
APPLICATION FOR APPOINTMENT OF A PERMANENT
GUARDIAN OF PERSON
TO THE HONORABLE JUDGE OF SAID COURT:
______, Applicant, files this application to be appointed as permanent Guardian of the Person of [insert name of proposed Ward] (“Proposed Ward” herein), pursuant to § 161.101 of the Texas Human Resources Code and § 682 of the Texas Probate Code. Applicant's address is [insert work address and city], [insert name of county] County, Texas [insert ZIP]. Applicant would show the Court the following:
I.
VENUE
[Insert name of proposed Ward], Proposed Ward, is a [male/female] born on [insert birth date]. Proposed Ward presently resides at [insert address and city], [insert name of county] County, Texas.
[Select the following paragraph if Proposed Ward is AOC under the age of 18; otherwise delete.]
The Proposed Ward is under the managing conservatorship of ______. This application is filed pursuant to § 682A of the Texas Probate Code to ensure that someone is responsible for the Proposed Ward when the managing conservatorship expires. The Proposed Ward will turn eighteen years of age within 180 days.
This Court, therefore, has jurisdiction and venue of this proceeding.
II.
CITATION AND NOTICE
Pursuant to § 633 of the Texas Probate Code, the following persons should be served by personal citation:
1. Proposed Ward, [insert name of proposed Ward], who must be personally served and may be located at [insert address and city], [insert name of county] County, Texas.
2. Proposed Ward’s mother, [insert mother’s full name], who must be personally served and may be located at [insert address and city], [insert name of county] County, Texas.
3. Proposed Ward’s father, [insert father’s full name], who must be personally served and may be located at [insert address and city], [insert name of county] County, Texas.
[Select the following paragraph if Proposed Ward is AOC under 18 years of age; otherwise delete.]
4. Proposed Ward’s spouse, [insert spouse’s full name], who must be personally served and may be located at [insert address and city], [insert name of county] County, Texas.
[If the Proposed Ward’s mother, father or spouse is deceased or cannot be located or if the parental rights of the Proposed Ward’s parents have been terminated by court order, include any of the following explanatory paragraphs as applicable and delete the others.]
[Proposed Ward’s mother, [insert mother’s full name], is deceased.] [or] [The whereabouts of the Proposed Ward’s mother, [insert mother’s full name], are unknown and cannot be reasonably ascertained.] [or] [The parental rights of the Proposed Ward’s mother were terminated by Court order on [insert date of termination order]. A copy of the termination order is attached.]
[Proposed Ward’s father, [insert father’s full name], is deceased.] [or] [The whereabouts of the Proposed Ward’s father, [insert father’s full name], are unknown and cannot be reasonably ascertained]. [or] [The parental rights of the Proposed Ward’s father were terminated by Court order on [insert date of termination order]. A copy of the termination order is attached.]
[Proposed Ward’s spouse, [insert spouse’s full name], is deceased.] [or] [Proposed Ward has no spouse.]
The Applicant requests that the Clerk of the Court issue the appropriate citation and notice to all parties named above at the addresses given as well as posting notice of this guardianship as required by § 633 of the Texas Probate Code.
Pursuant to § 633 of the Texas Probate Code, the following persons are entitled to be given notice of the proceedings. The Applicant will mail a copy of the application for guardianship and notice by registered or certified mail, return receipt requested, to the following persons:
1. Adult children of Proposed Ward:
[None] [OR]
[Adult children are deceased.] [OR]
[Adult children are as follows:]
[Enter name(s ) and address(es) of adult child(ren), if any; otherwise delete.]
2. Adult siblings of Proposed Ward:
[None] [OR]
[Adult siblings are deceased.] [OR]
[Adult siblings are as follows:]
[Enter name(s) and address(es) of adult sibling(s), if any; otherwise delete.]
[Delete the following paragraph if it is not applicable.]
Proposed Ward has an adult sibling who was adopted as a child by a family unconnected to the Proposed Ward. In accordance with Chapter 162 of the Texas Family Code, which makes the adoptive name confidential, the name and address of this adult sibling is not listed in this application. Applicant will send a certified letter to the last known address of the adopted sibling, thereby affording the sibling an opportunity to participate in this hearing. When the return receipt or unclaimed letter is returned to Applicant, Applicant will file an “Affidavit of Proof of Service” with the Court that does not disclose the identity or location of this sibling so as to keep this information confidential.
[If the Proposed Ward’s spouse and each of the Proposed Ward’s parents, siblings, and children are deceased, or, if there is no spouse, parents, adult siblings, or adult children, include the following paragraph; otherwise delete.]
3. The Proposed Ward’s adult next of kin who are known to the Applicant, pursuant to § 682 (12)(E) Texas Probate Code is/are:
[Enter name(s) and address(es) of any adult next of kin; otherwise, delete.]
4. The administrator or operator of the facility or institution in which the Proposed Ward resides is:
[Enter name and address.]
5. Person(s) named in paragraph XI. below known to hold a power of attorney signed by the Proposed Ward:
[Enter name(s) and address(es)if applicable; otherwise delete.]
6. The person designated to serve as guardian of the Proposed Ward by a written declaration pursuant to § 679 of the Texas Probate Code:
[Enter name and address, if applicable; otherwise delete.]
7. The person designated to serve as guardian of the Proposed Ward in the probated will of the last surviving parent of the Proposed Ward is:
[Enter name and address, if applicable; otherwise delete.]
8. The person designated to serve as guardian of the Proposed Ward by a written declaration of the Proposed Ward’s last surviving parent, if the declarant is deceased:
[Enter name and address, if applicable; otherwise delete.]
III.
MINOR CHILDREN
Pursuant to § 682(12)D) of the Texas Probate Code, the Applicant lists the following minor children of the Proposed Ward; however, they are not required to be served under § 633:
[Enter name, age and address of each of the Proposed Ward’s minor children, if any or enter the fact they are deceased; otherwise delete paragraph and renumber.]
IV.
MINOR SIBLINGS
Pursuant to § 682(12)(E) of the Texas Probate Code, the Applicant lists the following minor siblings of the Proposed Ward; however, they are not required to be served under § 633:
[Enter name, age and address of each of the Proposed Ward’s minor siblings, if any or the fact they are deceased; otherwise delete paragraph and renumber.]
V.
PROPOSED GUARDIAN
Proposed Ward is incapacitated to a degree requiring a permanent guardianship, and Proposed Ward has no one who is able to properly take care of or protect Proposed Ward’s person. There is no one known, other than Applicant, willing to make application for appointment as guardian and able to perform the duties of guardian, therefore Applicant is qualified and suitable to serve as guardian.
VI.
REASON FOR GUARDIANSHIP
[For a limited guardianship, alter the following paragraph accordingly.]
The appointment of a Guardian of the Person of Proposed Ward is necessary because Proposed Ward is incapacitated as a result of a mental [and/or] physical condition that makes the Proposed Ward substantially unable to provide food, clothing, or shelter, or to care for [his/her] own physical health, as evidenced by recurring acts or occurrences within the preceding six-month period and not by isolated instances of negligence or bad judgment.
[Specify the reasons the guardianship is needed, i.e. Proposed Ward is suffering from Alzheimer’s Disease, has had a stroke, is comatose, has severe head injuries, is a person with mental retardation, etc.]
[Select the correct paragraph below and delete the other.]
The nature and degree of the incapacity are set forth in a written letter or certificate from a physician licensed in the state of Texas, pursuant to § 687(a) of the Texas Probate Code, from, [insert name of physician], M.D., attached as Exhibit A. Exhibit A is hereby incorporated by reference as if recited verbatim herein.
[OR]
The nature and degree of the Proposed Ward’s incapacity are set forth in written documentation, pursuant to § 687(c) of the Texas Probate Code, attached hereto as Exhibit A, showing that the Proposed Ward has been examined or an endorsement completed according to the rules adopted by Mental Retardation Authority Services (formerly the Texas Department of Mental Health and Mental Retardation) not earlier than twenty-four months before the date of this hearing and these documents contain written findings and recommendations. Also attached [is/are] [and the Affidavit of APS Specialist as Exhibit B]. Exhibits A [and B] are hereby incorporated by reference as if recited verbatim herein.
VII.
POWERS REQUESTED BY GUARDIAN
[For a limited guardianship, delete the phrase, “but not limited to,” in the following paragraph.]
The Applicant requests that the Court find the Proposed Ward incapacitated for [all purposes] [or] [limited purposes] and [totally] [or] [partially] without capacity to care for [himself/herself]. Applicant requests [full powers] [or] [limited powers] as Guardian of the Person including, [but not limited to], the following:
[For limited guardianship, delete powers that do not apply.]
a) the power to review, to take possession of and consent to the disclosure of the Proposed Ward’s medical, dental, and psychological records;
b) the power to apply for, arrange for, and consent to any and all psychological, psychiatric, or medical examinations, treatments, tests, or evaluations for the Proposed Ward, but not the authority to consent to in-patient psychiatric commitment of the Proposed Ward;
c) the power to consent or to object to all medical and dental treatment and procedure for the Proposed Ward, including surgery, unless consent by a guardian is prohibited by other law;
d) pursuant to §§ 166.039 and 166.088 of the Texas Health and Safety Code, the power to make a treatment decision that may include a decision to withhold or withdraw life-sustaining treatment from the Proposed Ward and the power to execute an Out-of-Hospital Do-Not-Resuscitate (DNR) Order on behalf of the Proposed Ward;
e) the right to take charge of and supervise the person of the Proposed Ward, establish the legal domicile of the Proposed Ward, and place the Proposed Ward in appropriate living facilities;
f) the power to consent to appropriate educational, vocational and recreational services for the Proposed Ward;
g) the power to access all government funds and services to which the Proposed Ward may be entitled.
VIII.
LIMITATIONS OF WARD
The Applicant requests that the Court impose limitations on the Proposed Ward that are consistent with the powers requested by the guardian in paragraph VII. of this application including, but not limited to the following:
[For limited guardianship, delete the limitations that do not apply.]
For Guardianship of the Person, that the Proposed Ward no longer have the right to:
a) operate a motor vehicle;
b) vote in a public election or any other matter;
c) consent to marriage;
d) execute a will, or make a codicil or amendment to any existing will;
e) execute a trust or make an amendment to any existing trust;
f) execute a power of attorney or make an amendment to any existing power of attorney;
g) make decisions or give consent to medical or surgical treatment;
h) choose his or her domicile or residence; or
i) personally to seek employment, obtain government assistance or access government benefits or funds.
IX.
OTHER GUARDIANSHIPS
[Select the correct paragraph and delete the other.]
To the best of Applicant's knowledge, there are no guardianships existing or pending of any kind for Proposed Ward in the State of Texas or any other state.
[OR]
A guardianship of the [person] [estate] [person and estate] of Proposed Ward exists in the State of [Texas] [insert name of other state]. This guardianship was established on or about [insert date] by [insert name of court] Court under Cause No. [insert cause no.] in [insert name of county] County, [Texas] [insert name of other state].
X.
PROPERTY
[Select the correct paragraph below and delete the other. If the Proposed Ward has real property, enter the street address and legal description in the space provided. If there is property other than government benefits, the attorney will need to describe how it will be handled without DADS as Guardian of the Estate.]
To the best of Applicant's knowledge and belief, Proposed Ward owns:
[No real property.]
[OR]
[The following real property located at [insert address and city], [insert name of county] County, Texas, more particularly described as follows:]
[Insert legal description, e.g., the Lot & block description of the property.]
[Select the correct paragraph below and delete the other.]
To the best of Applicant’s knowledge and belief, Proposed Ward owns:
[No personal property, other than personal effects.]
[OR]
[The following personal property:] [Include any compensation, pension, insurance, or allowance to which the Proposed Ward may be entitled, if known and add additional lines, if necessary.]
Description of Property / Estimated Valuea. A [checking/savings] account at [insert name of financial institution] in [insert name of city], Texas with funds in the approximate amount of / $
b. [Insert year, make, model] motor vehicle, VIN [insert VIN No.]
with approximate value of / $
c. / $
d. / $
TOTAL / $
Proposed Ward's monthly income is $[insert amount]: $[insert amount] from non-governmental sources [insert name of pension/annuity/allowance]; and $[insert amount] in governmental benefits.
[Delete the following statement if estate has sufficient funds to support the Proposed Ward and pay ad litem.]
Applicant requests that the Court find the Proposed Ward to be indigent.