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Petition For Appointment Of Conservator GN-3350 - Wisconsin
|Petition For Appointment Of Conservator Form. This is a Wisconsin form and can be used in Guardianship Circuit Court Statewide .||
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FORM SUMMARY Name of Form Form Number Petition for Appointment of Conservator GN-3350 Statutory Reference Benchbook Reference Purpose of Form Who Completes It: Distribution of Form Accompanying Forms: New Form/Modification: Modifications: Comments: About this Form: §54.76, Wisconsin Statutes GA-1, GA-2 and GA-6 Petition for appointment of a conservator of estate Petitioner or attorney. Original to court. Modification, last update 7/01 Modified to comply with 2005 Wis. Acts 264, 387 and 388. PLEASE BE INFORMED: This form is based on unofficial text from Revisor of Statutes. This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Date: 10/05/2006 Page 1 American LegalNet, Inc. www.FormsWorkflow.com For Official Use STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Amended Petition for Appointment of Conservator Case No. Date of Birth UNDER OATH, I STATE THAT: 1. I am unwilling or believe I am unable to properly manage my assets or income and voluntarily ask the court to appoint a conservator. 2. I am an adult resident of My post office address is: County, State of Wisconsin. 3. The approximate value of my property is as follows: Amounts General Description Cash/Bank Accounts: $ Real estate: $ General Description Other Liquid Assets: Other Assets: Amounts $ $ A. Assets previously derived from or benefits now due and payable from U.S. Department of Veterans Affairs See attached. none are: B. I am receiving public benefits, including medical assistance, SSI, SSDI or long term community options Yes, type and amount: No program benefits: C. Any other claim, income, compensation, pension, insurance or allowance to which I may be entitled is: See attached. as follows: none. Amounts (monthly) General Description Amounts (monthly) General Description Social security $ Investment Income $ Pension $ Other $ do have a current, valid financial durable power of attorney. do not 4. I phone number: Activated. Name, address and 5. I nominate as conservator of my estate: Type of Conservator Conservator Standby Conservator Name & Address See attached. Phone 6. I petition the court to: A. Appoint a consevator of my estate with: 1. duties under §54.19; 2. standard powers under §54.20(1), and 3. powers that do not require court approval under §54.20(3) limited full Conservator of estate's authority: B. Authorize the conservator of the estate to exercise additional powers requiring court approval under §54.20(2), other than to make gifts, as follows: C. I request that bond be waived. set by the court. GN-3350, 10/06 Petition for Appointment of Conservator §54.76, Wisconsin Statutes Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com This form shall not be modified. It may be supplemented with additional material.