Form 4: Notice of Application and Hearing – Appointment of Co-Decision-Maker - Alberta Human Services - Government of Alberta

Form 4: Notice of Application and Hearing – Appointment of Co-Decision-Maker

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This form is used to provide notice to others that an application for a Co-decision-making Order has been made and it will be heard before a Justice in Court of Queens Bench. This notice is sent to the people indicated in the application.

If you need more lines, please click “add more” and additional sections will be added to the form. If you are printing the forms and need more room, please attach an additional piece of paper with the information and mark which section the information relates to. This is applicable to any description field.

Court File Number: Leave blank. A court file number will be assigned when the documents are filed. Do not write anything in the court stamp box.

Judicial Centre: Leave blank. The application will be made in the appropriate judicial centre having regard to where the assisted adult (hereafter called the adult) resides.

Full Name of the Adult: Fill in full legal name of the adult. Do not use nicknames or abbreviations. Use the same name all the way through the documents.

Applicant’s Name: Fill in full legal name of the person making the application; do not use nicknames or abbreviations. Use the same name throughout the documents.

1. Enter the applicants name in the first space and the Adult’s full name in the second space.

2. The Court sets the Hearing date – enter this information once you have received it from the Court.

3. Enter the name and relationship to the Adult of the proposed co-decision-maker(s).

4. Please check the appropriate box(es) that match Section 6.1 of your Application (Form 1). Also, you can refer to the capacity assessment report where the capacity assessor will have identified the authority the co-decision-maker will need to assist the adult.

Note: “Any other personal matters….” Only check this box if you require authority in a specific area , e.g., specific diet that is not health related, such as a vegetarian diet or a religion base diet or refusal of a blood transfusion on religious grounds.

5. This statement is confirming the adult has consented to the co-decision-making order.

6. Please indicate which documents you have filed that an interested person may obtain copies of.

7. This section is instructions and information for the person receiving the notice of application.

The final box is for your address and contact information. If you are a lawyer completing this form, complete the first three lines with your information. If you do not have a lawyer completing this notice, do not complete the first three lines with law firm name, responsible lawyer’s name and lawyer’s file number. Complete the final lines with your street address, and other contact information as indicated.

Modified: 2015-04-21
PID: 16383

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1-877-427-4525 (toll-free)

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