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Petition For Guardianship Due To Incompetency GN-3100 - Wisconsin
| Petition For Guardianship Due To Incompetency Form. This is a Wisconsin form and can be used in Guardianship Circuit Court Statewide . |
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STATE OF WISCONSIN, CIRCUIT COURT, Amended COUNTY For Official Use IN THE MATTER OF Petition for Temporary Permanent Guardianship Due to Incompetency Case No. Date of Birth FOR ALL GUARDIANSHIPS (Complete #1 through #10) UNDER OATH, I STATE: 1. I am interested as a relative. I am related to the individual as a public official. My authority to act as petitioner is Other: 2. This petition is filed in the county of residence of the individual. the county in which the individual is physically present. Other: 3. The individual lives in and the individual's mailing address is County, State of , . . . . 4. The name and mailing address of the person or institution, if any, that has care and custody of the individual or the facility, if any, that is providing care to the individual is: Name Phone Number Mailing Address This petition for guardianship is filed with a petition for protective placement prior to transfer of the individual directly from a hospital to a nursing facility or community-based residential facility under §50.06, Wisconsin Statutes. 5. I have exercised due diligence to locate all interested parties. The names and mailing addresses of all interested parties (including the petitioner) and all others entitled to notice are as follows: See attached Name Relationship Mailing Address GN-3100, 03/12 Petition for Temporary Guardianship and/or Permanent Guardianship Due to Incompetency §§50.06, 54.10(3), 54.34, 54.44(1), 54.50, 54.852(7) and Ch. 54, Wisconsin Statutes American LegalNet, Inc. www.FormsWorkFlow.com This form shall not be modified. It may be supplemented with additional material. Page 1 of 7 Petition for Temporary Guardianship and/or Permanent Guardianship Due to Incompetency Page 2 of 7 Case No. 6. The individual, if married, does does not have children who are not of the current marriage. 7. The individual does does not have a current, valid financial durable power of attorney. This document is is not activated. Agent's Name, mailing address and phone does does not have a current, valid power of attorney for health care. This document is is not activated. Agent's Name, mailing address and phone does does not have other advance planning to avoid guardianship. If the above-named powers of attorney or advanced planning exist, guardianship is still necessary because . See attached 8. I am not aware aware of a guardianship or conservatorship or related proceeding or ordered proceeding involving the individual in another state or county. The details of the guardianship, conservatorship, or related proceedings of which I am aware are as follows: See attached guardian or conservator appointed in Wisconsin (Name and county where appointed) guardian or conservator appointed out-of-state (Name and state where appointed) 9. The following person is nominated as guardian: Type of Guardian Name & Mailing Address Guardian of the Person Guardian of the Estate Temporary Guardian of the Person Temporary Guardian of the Estate Standby Guardian of the Person Standby Guardian of the Estate 10. A. The approximate value of individual's property is: General Description Amounts Cash/Bank Accounts: Real Estate: $ $ See attached Phone General Description See attached Amounts $ $ Other Liquid Assets: Other Assets: B. Assets of individual previously derived from or benefits of individual now due and payable from U.S. Department of Veterans Affairs are none See attached C. The individual receives public benefits, including medical assistance, SSI, SSDI or long term community options program benefits. No Yes, type and amount D. Any other claim, income, compensation, pension, insurance or allowance to which the individual may be entitled is none. as follows: See attached General Amounts Amounts General Description Description (monthly) (monthly) Social Security Pension Disability $ $ $ Investment Income Other: Other: $ $ $ GN-3100, 03/12 Petition for Temporary Guardianship and/or Permanent Guardianship Due to Incompetency §§50.06, 54.10(3), 54.34, 54.44(1), 54.50, 54.852(7) and Ch. 54, Wisconsin Statutes American LegalNet, Inc. www.FormsWorkFlow.com This form shall not be modified. It may be supplemented with additional material. Page 2 of 7 Petition for Temporary Guardianship and/or Permanent Guardianship Due to Incompetency Page 3 of 7 Case No. FOR PERMANENT GUARDIANSHIP 11. (Complete #11 through #17) A. A report of examination by a physician or psychologist is filed with this petition. will be filed with the court and provided by the petitioner to the guardian ad litem and the attorney for the proposed ward or ward at least 96 hours before the time of the hearing. B. Certificate of Administrator (or representative) of U.S. Department of Veterans Affairs is filed with this petition. 12. A sworn and notarized Statement of Acts by Proposed Guardian and Consent to Serve filed with this petition. will be filed at least 96 hours before the hearing. 13. The individual is alleged to be incompetent as a result of the following impairment a developmental disability. serious and persistent mental illness. degenerative brain disorder. other like incapacities. A guardian is requested to be appointed for the individual based upon the following standards: A. The individual will be at least 17 years and 9 months of age as of the date of the hearing. B. The individual's need for assistance in decision-making or communication is unable to be met effectively and less restrictively through appropriate and reasonably available training, education, support services, health care, assistive devices, or other means that the individual will accept. C. (For appointment of guardian of the person) The individual, because of impairment, is unable effectively to receive and evaluate information or to make or communicate decisions to such extent that the individual is unable to meet the essential requirements for the individual's physical health and safety. D. (For appointment of guardian of the estate) The individual, because of an impairment, is unable effectively to receive and evaluate information or to make or communicate decisions related to management of the individual's property or financial affairs, to the extent that at least one of the following applies: (1) The individual has property that will be dissipated in whole or in part; or (2) The individual is unable to provide for the individual's support; or (3) The individual is unable to prevent financial exploitation. 14. The specific nature of the individual
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