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Ily Court: The undersigned hereby certifies under the penalties of perjury that I am a registered physician and that I personally examined (name of proposed ward) (city or town) (street address) (state) on (date of examination) and in my opinion the proposed ward: is unable to properly care for his/her property due to mental weakness. is incapable of caring for his/her property due to a physical incapacity. When seeking a conservatorship of a person with a physical incapacity ONLY the ward m.

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