Kenneth Vercammen & Associates, P.C.
2053 Woodbridge Ave.
Edison, NJ 08817
(732) 572-0500
www.njlaws.com

Monday, August 24, 2009

Order Scheduling Guardianship Hearing 11220

Model Order for Scheduling Hearing for Guardianship
of Alleged Incapacitated Person (Rule 4:86-4) -
Promulgated by Directive #10-08

Promulgated by Directive #10-08 (05/20/08), CN 11220-English page 1 of 2

In the Matter of , an
Alleged Incapacitated Person

SUPERIOR COURT OF NEW JERSEY
CHANCERY DIVISION COUNTY
PROBATE PART
Docket No.:
CIVIL ACTION
ORDER FIXING GUARDIANSHIP
HEARING DATE AND APPOINTING
ATTORNEY FOR ALLEGED
INCAPACITATED PERSON


This matter having been opened to the Court by ________________________ , attorney for
the plaintiff, __________________________________________ for a judgment declaring
_________________________ an incapacitated person and appointing a guardian pursuant to
N.J.S.A. 3B:12-24.1 and Rules 4:86-1 to 8 and for such other relief as the Court may deem just, and
the Court having read and considered the verified complaint, the supporting certifications or
affidavits, and all other papers and pleadings filed in this matter, and for good cause shown:
IT IS on this ________ day of __________________, 20___, ORDERED that:
1. This matter be set down for hearing before this Court at the ______________ County
Court House, _______________________________, New Jersey, on the _________ day of
__________________, 20___ , at ________ o’clock in the ______ noon, or as soon thereafter as
plaintiff may be heard, to determine the issues of incapacity of _____________________________
and the appointment of a guardian.
2. A copy of the verified complaint, supporting affidavits or certifications and this Order,
shall be served on _____________________________, the alleged incapacitated person, by
personally serving the same at least 20 days prior to the date scheduled for the hearing.
3. A separate notice shall be personally served on the alleged incapacitated person stating
that if he/she desires to oppose the action he/she may appear either in person or by attorney and may
demand a trial by jury.
4. A copy of the verified complaint, supporting affidavits or certifications and this Order
shall also be served on all the next-of-kin and other parties-in-interest identified in the verified
complaint by certified mail, return receipt requested at least 20 days prior to the date scheduled for
the hearing.

Promulgated by Directive #10-08 (05/20/08), CN 11220-English page 2 of 2
5. _________________, Esquire, whose address is: _____________________________ and
telephone number is: _______________________ be and hereby is appointed as attorney for the
alleged incapacitated person. Said attorney shall personally interview the alleged incapacitated
person, examine the medical records, make inquiry of persons having knowledge of the alleged
incapacitated person’s circumstances, his/her physical and mental state and his/her property, make
reasonable inquiries to locate any Will, powers of attorney or health care directives previously
executed by the alleged incapacitated person, or to discover any interests the alleged incapacitated
person may have as a beneficiary of a will or trust. Said attorney shall prepare a written report of
findings and recommendations and an affidavit of services to be filed with the Court and with the
plaintiff’s attorney and other parties who have filed a written response at least ____ days prior to the
hearing.
6. A copy of the verified complaint, supporting affidavits or certifications and this Order
shall be immediately served on the attorney for the alleged incapacitated person by personal service
or certified mail, return receipt requested.
7. The attorney above appointed to represent the alleged incapacitated person is hereby
regarded as a HIPAA (Health Insurance Portability and Accountability Act) representative for the
alleged incapacitated person and shall have the right and power to examine records, including
medical and psychiatric records, pertaining to the alleged incapacitated person and to visit and
confer with the alleged incapacitated person.
8. The plaintiff shall file with the Surrogate of _________ County a proof of service of the
pleadings required by this order to be served on the alleged incapacitated person and the parties in
interest no later than _____ (__) days before the date this matter is scheduled to be heard.
9. Any next-of-kin and other party-in-interest who wishes to be heard with respect to any of
the relief requested in the verified complaint shall file with the Surrogate of ______________
County at [insert address of Surrogate in the County where the action is being brought] together
with the applicable filing fee and serve upon the attorney for the plaintiff and the attorney for the
alleged incapacitated person at the address set forth above, a written answer, an answering affidavit ,
a motion returnable on the date this matter is scheduled to be heard or other written response _____
days before the date this matter is scheduled to be heard.

__________________________________
J. S. C.

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