PS–17 

Rev. 5/10 

Notice of Possible Incompetency 

Case Number:  
 

In the (check one):  (cid:134) Circuit (cid:134) District (cid:134) Small Claims   Court of  

 County, Alabama 

Plaintiff’s Name 

Defendant’s Name  

 

  v. 

 

 

q  My name is (print):  
w  My contact information is: 

 

 

street address  

city 

state 

zip code 

(           ) 
phone #  

I have known or taken care of the Defendant for  

e 
r  My relationship to the Defendant is (describe):  

 years. 

t  Since (date):  
(explain):  

, the Defendant has been ill or unable to care for him/herself because  
 
 

y  Has any court or government agency, such as VA, Social Security, etc., made a decision about the 

Defendant’s mental status?  (cid:134) Yes (cid:134) No 
If Yes, list the name of that agency and describe the decision they made:  
 

u  The Defendant does not have a guardian, court-appointed guardian, or lawyer.  

I swear that the information I have provided above is true.  

Sign here, then go to o below:  

 Date:  

  

 

 

 

 
 

 

© 2010 Alabama State Bar 

Certificate of Service — I certify that a true copy of this 

Notice was delivered or mailed to the Plaintiff or his/her 

, at the address below. 

 Date:  

city 

zip 

lawyer on (date):  

Sign here:  

treet address 

state 

  s

  After signing above, you must: 

1.  Fill out the box to the right, then   

2.  Mail or deliver a copy of this form to 
the Plaintiff or his/her lawyer, then 

3.  File the original of this Notice with the 

court clerk. 

 
 

 

 

 

i 

  o

 

 

Rev. 5/10