) IN CIRCUIT COURT ) COUNTY OF _________________ ) __________ JUDICIAL CIRCUIT ) ****************************************************************************** In the Matter of the Guardianship and ) ____GDN________________ ) GUARDIAN & CONSERVATOR'S Conservatorship of ____________________, ) PETITION TO ) MODIFY TERMINATE a Minor Protected Person. ) GUARDIANSHIP & CONSERVATORSHIP ****************************************************************************** I/We, __________________________ , the Guardian-Conservator(s) for the above-mentioned Individual, being duly sworn upon oath, state and affirm the following: 1. I was appointed guardian and 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: a. With regard to the guardianship: (select one) RETAIN TERMINATE MODIFY as follows: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ UJS-150 Guardian & Conservator's Petition to Modify / Terminate Guardianship & Conservatorship (Generally) Rev. 05/2016 American LegalNet, Inc. www.FormsWorkFlow.com b.With regard to the conservatorship: (select one) RETAIN TERMINATE MODIFY as follows: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ c. This request to modify and/or terminate is based on (1) my observations that the need for the guardianship or conservatorship has changed AND/OR (2) the fact that the current Guardian-Conservator(s) are unable or unwilling to exercise the assigned duties and no other suitable guardian-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), and Final Report, if ordered [Minor] or not waived by the Court [Protected Person] per SDCL 29A-5-401, -403. Dated ______________ ___ , ________ (month) (day) (year) _______________________________________ Guardian-Conservator's Signature (Sign only in front of Notary or Clerk) ____________________________________ Mailing Address ____________________________________ City, State, and Zip Code ____________________________________ Phone Number ____________________________________ E-mail Address _______________________________________ Co-Guardian-Conservators' Signature(s) (if any) UJS-150 Guardian & Conservator's Petition to Modify / Terminate Guardianship & 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)