) IN CIRCUIT COURT ) COUNTY OF _________________ ) __________ JUDICIAL CIRCUIT ) ****************************************************************************** In the Matter of the Conservatorship of ) ____GDN________________ ) ___________________________________, ) CONSERVATOR'S PETITION TO ) MODIFY TERMINATE a Minor Protected Person. ) CONSERVATORSHIP ****************************************************************************** I/We, __________________________ , the Conservator(s) for the above-mentioned Individual, being duly sworn upon oath, state and affirm the following: 1. I was appointed conservator of the above-mentioned Individual on __________________ (month), _____ (day), __________ (year). 2. I provide the following assistance, services, and protection to the Individual (please detail): ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. My contact with the Individual includes (please describe frequency and types of contact--in person, over the phone, etc.--and also describe the Individual's ability to communicate): _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ STATE OF SOUTH DAKOTA 4. As a result of these contacts, I request the Court (select one): a. TERMINATE the conservatorship, or MODIFY the conservatorship as follows: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ UJS-148 Conservator's Petition to Modify / Terminate Conservatorship (Generally) Rev. 05/2016 American LegalNet, Inc. www.FormsWorkFlow.com b. This request to modify or terminate is based on (1) my observations that the need for the conservatorship has changed AND/OR (2) the fact that the current Conservator(s) are unable or unwilling to exercise the assigned duties and no other suitable conservator candidate is capable or willing (please explain below): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ I/We swear or affirm under oath that the information I/we provided in this Petition and Affidavit is true and correct to the best of my/our knowledge. I/We affirm that this Petition and Affidavit is brought in the best interests of the above-named Individual. I/We request a hearing on this Petition pursuant to SDCL 29A-5-508. If I/we seek to terminate, attached to this Petition is the Final Accounting and Objection Notice (if not waived by the Court per SDCL 29A-5409). Dated ______________ ___ , ________ (month) (day) (year) _______________________________________ Conservator's Signature (Sign only in front of Notary or Clerk) ____________________________________ Mailing Address ____________________________________ City, State, and Zip Code ____________________________________ Phone Number ____________________________________ E-mail Address _______________________________________ Co-Conservators' Signature(s) (if any) UJS-148 Conservator's Petition to Modify / Terminate Conservatorship (Generally) Rev. 05/2016 American LegalNet, Inc. www.FormsWorkFlow.com Sworn/affirmed before me this _____ day of __________________, 20____. _____________________________________ (Notary Public / Clerk of Courts) If Notary, my commission expires: __________ (SEAL)