Aoc 740 Form PDF Details

The AOC 740 form is a document used to request an administrative review of a Social Security determination. The form can be used to request a review of any determination made by the Social Security Administration (SSA), such as a decision about eligibility for benefits or the amount of benefits payable. The AOC 740 form must be completed and filed within 60 days of the date of the notice you received from SSA indicating their decision. If you disagree with a Social Security determination, you may be able to challenge it by filing an administrative appeal. The AOC 740 form is one way to request an administrative review of a Social Security decision. This form can be used to ask for a review of any decision made by the SSA

QuestionAnswer
Form NameAoc 740 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesky aoc 740, aoc740 form, 2020 ky income tax form740, kentucky aoc 740 fillable

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AOC-740

Doc. Code: PDD

 

 

 

 

 

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Rev. 7-18

 

 

 

 

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Case No. ____________________

 

 

 

 

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Court of Justice

 

 

 

 

 

 

 

 

 

 

 

www.courts.ky.gov

PETITION TO DETERMINE

Division

____________________

KRS 387.530; 210.290

IF DISABLED

 

 

COMMONWEALTH OF KENTUCKY

 

 

 

 

 

 

 

 

 

 

PETITIONER

VS.

 

 

 

 

 

 

 

 

 

 

 

 

 

________________________________________________

 

 

 

 

RESPONDENT

____________________________________________________ has reasonable grounds or knowledge to lead him/her

to believe Respondent appears to be unable to provide for his/her physical health and safety and/or manage his/her financial resources effectively and submits to the Court the following facts upon which he/she supports this belief:

1.Name of Petitioner: ____________________________________________________________________________

Address: ____________________________________________________________________________________

Telephone Number: _______________________________

Petitioner’s relationship to Respondent: _______________________________

2.Name of Respondent: _________________________________________________________________________

Respondent’s Date of Birth (if known): _______________________________

3.Respondent's Permanent, Full-time Residence: ______________________________________________________

Address

_____________________________________________________________________________________________

a.Respondent has resided at this address for the previous_____ years _____ months.

b.Is this address a hospital, treatment facility, correctional facility, or long-term care facility? q Yes q No

4.Is Respondent currently physically located at his or her permanent address above? q Yes q No If No, (check one): q a. Respondent is currently located at: ____________________________________________________________

q b. Respondent's current location is unknown at this time.

5. Is Respondent a citizen or a permanent resident of the United States?

Address

q Yes q No

6.Has Respondent been convicted of, pled guilty to, or entered an Alford plea for a felony sex crime as defined in KRS 17.500? q Yes q No q Unknown

7.Has Respondent been convicted of, pled guilty to, or entered an Alford plea for a felony offense that would classify the person as a violent offender under KRS 439.3401? q Yes q No q Unknown

8.The nature of Respondent’s disability and the facts or reasons supporting the need for determination of disability are:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

9.Respondent owns the following estate, including government benefits, insurance entitlements, and anticipated yearly income (state none or unknown):

ESTATE

VALUE

Real Property

$____________________

Personal Property

$____________________

Yearly Income

$____________________

Source of Yearly Income _________________________________________________________________________

_____________________________________________________________________________________________

AOC-740

Rev. 7-18

Page 2 of 2

10.Name of q Person or q Facility having custody of Respondent: ___________________________________

Address: _________________________________________________________________________________

11.Respondent’s q Durable Power of Attorney OR q Health Care Surrogate is:

Name: ___________________________________________________________________________________

Address: _________________________________________________________________________________

12.Respondent’s next of kin:

Name: ___________________________________________________________________________________

Address: _________________________________________________________________________________

_________________________________________________________________________________________

Relationship to Respondent: _______________________________

Name: ___________________________________________________________________________________

Address: _________________________________________________________________________________

_________________________________________________________________________________________

Relationship to Respondent: _______________________________

WHEREFORE, Petitioner requests the Court inquire into Respondent’s ability to care for himself/herself and to manage his/her financial resources. Petitioner attaches an Application for Appointment of Fiduciary and further requests:

1.Trial by jury;

2.Counsel to represent the Respondent; and

3.Court appointment of a physician, advanced practice registered nurse, or physician assistant; a psychologist; and a social worker to evaluate Respondent as provided by law unless the evaluation report is filed with this Petition.

_____________________________, 2______

___________________________________________

Date

Signature of Petitioner

SUBSCRIBED and SWORN to before me this ___________ day of _______________________________, 2_______.

My Commission expires:____________________________.

____________________________________________

____________________________________________

County, Kentucky

Name/Title

To be completed if Petitioner is represented by counsel:

Attorney’s Name: ________________________________________________________________________________

Address: _______________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Telephone Number: _______________________________

____________________________________________

Attorney Signature

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Filling out this form calls for focus on details. Make sure that each field is filled out accurately.

1. The aoc 740 needs specific information to be typed in. Be sure that the next blank fields are complete:

Filling out section 1 of ky income tax forms 740

2. The next part would be to complete all of the following blanks: Name of Respondent , Respondents Date of Birth if known , Respondents Permanent Fulltime, Address, a Respondent has resided at this, Is Respondent currently, Address, Is Respondent a citizen or a, Has Respondent been convicted of, q Yes q No q Unknown, Has Respondent been convicted of, person as a violent offender under, The nature of Respondents, and Respondent owns the following.

Step number 2 in filling out ky income tax forms 740

3. This next step is generally simple - fill in all of the form fields in income state none or unknown ESTATE, VALUE, Real Property, Personal Property, Yearly Income, and Source of Yearly Income to complete this part.

How to prepare ky income tax forms 740 portion 3

4. All set to complete this fourth segment! Here you will have all of these AOC Rev Page of , Name of q Person or q Facility, Respondents next of kin Name , WHEREFORE Petitioner requests the, Trial by jury, and Counsel to represent the blank fields to fill out.

AOC Rev Page of , WHEREFORE Petitioner requests the, and Trial by jury in ky income tax forms 740

5. To wrap up your document, this particular segment has a few extra blank fields. Typing in Court appointment of a physician, Date, Signature of Petitioner, SUBSCRIBED and SWORN to before me, My Commission expires, County Kentucky, NameTitle, To be completed if Petitioner is, Attorneys Name , Address , Telephone Number , and Attorney Signature is going to finalize the process and you'll be done very quickly!

Court appointment of a physician, County Kentucky, and My Commission expires inside ky income tax forms 740

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