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Statement Of Acts By Proposed Guardian And Consent To Serve As Guardian GN-3140 - Wisconsin
|Statement Of Acts By Proposed Guardian And Consent To Serve As Guardian Form. This is a Wisconsin form and can be used in Guardianship Circuit Court Statewide .||
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FORM SUMMARY Name of Form: Statement of Acts by Proposed Guardian and Consent to Serve as Guardian GN-3140 Form Number: Statutory Reference: §§223.105(2), 54.15(8), 54.15(9), 54.60, and 54.62, Wisconsin Statutes GA-1, GA-2 Statement of Acts of proposed guardian and consent of guardian to serve. Petitioner or attorney. Original to court. Benchbook Reference: Purpose of Form: Who Completes It: Distribution of Form: Accompanying Forms: New Form/Modification: Modifications: Modified; last update 10/06. Changed Department of Health and Family Services to Department of Health Services (DHS). Combined Statement of Acts with Consent to Serve. 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. Comments: About this Form: Date: 04/24/2008 Page 1 American LegalNet, Inc. www.FormsWorkflow.com For Official Use STATE OF WISCONSIN, CIRCUIT COURT, Amended COUNTY IN THE MATTER OF Statement of Acts by Proposed Guardian and Consent to Serve as Guardian Case No. Date of Birth UNDER OATH, I STATE THAT THE FOLLOWING IS TRUE: I am the proposed guardian of the individual. I submit to the court this statement at least 96 hours before the court hearing. I am the proposed temporary guardian of the individual and I submit to the court this statement. 1. I am currently charged with or have been convicted of a crime (misdemeanor or felony): Yes If Yes, describe circumstances: No 2. I have filed for or received protection under the federal bankruptcy laws: Yes If Yes, describe circumstances: No 3. Any license, certificate, permit, or registration that I am required to have under chs. 440 to 480, Wisconsin Statutes or by the laws of another state for the practice of a profession or occupation has been suspended or revoked: Yes If Yes, describe circumstances: No 4. I am listed in the Caregiver Misconduct Registry of the Department of Health Services under §146.40 (4g)(a)(2), Wisconsin Statutes. Yes If Yes, describe circumstances: No 5. I am currently a guardian of the person of 5 or more adult wards who are unrelated to me: Yes If Yes, describe circumstances: No successor standby guardian guardian temporary guardian 6. I am nominated to serve as: estate of the above named individual and consent to serve as guardian and will act person guardian of the in the best interest of this individual. 7. If appointed as guardian of the person, I will file the Annual Report on the Condition of the Ward. 8. If appointed as guardian of estate, I will file the Guardianship Inventory within 60 days of appointment, and the Account of Guardian or Conservator annually and/or as otherwise required. 9. I will exercise all powers and perform all duties as guardian as required by law. Subscribed and sworn to before me on Signature of Proposed Guardian Notary Public, State of Wisconsin Name Printed or Typed My commission expires: Name of Attorney Address Phone Number Address Telephone Number Bar Number GN-3140, 04/08 Statement of Acts by Proposed Guardian and Consent to Serve as Guardian §§223.105(2), 54.15(8), 54.15(9), 54.60, and 54.62 Wisconsin Statutes American LegalNet, Inc. www.FormsWorkflow.com This form shall not be modified. It may be supplemented with additional material.