) IN CIRCUIT COURT ) COUNTY OF _________________ ) __________ JUDICIAL CIRCUIT ) ************************************************************************************ In the Matter of the Conservatorship of ) ____GDN________________ ) ______________________________, ) PETITION TO TERMINATE ) CONSERVATORSHIP a Minor Protected Person. ) ON DEATH ************************************************************************************ I, __________________________ , Conservator for the above-named Individual, being duly sworn upon oath, state and affirm the following: I was appointed conservator of the above-named Individual on _______________ (month), _____ (day), __________ (year). This conservatorship has since terminated when the Individual died at __________ (time), on the ___ day of _______________(month), ___________ (year), pursuant to SDCL 29A-5-507. Attached to this Petition is a Certified Copy of the Death Certificate as proof of death, pursuant to SDCL 29A-1-107(2). If not waived by the Court, a Conservator's Final Accounting is attached per SDCL 29A-5-408(4), along with the notice to the parties regarding written objections, pursuant to SDCL 29A-5-408. I request the Court enter an Order Terminating the Conservatorship and Order Accepting the Final Accounting (if applicable), and that Letters of Conservatorship be revoked (and any bond released). Dated ______________ ___ , ________ (month) (day) (year) STATE OF SOUTH DAKOTA ____________________________________ Conservator's Signature (Sign only in front of Notary or Clerk) ____________________________________ Mailing Address ____________________________________ City, State, and Zip Code ____________________________________ Phone Number ____________________________________ E-mail Address Signed and sworn to before me on this ______ day of _________________, ________. __________________________________ Notary Public/Deputy Clerk of Courts Commission Expires: UJS-155 Petition to Terminate Conservatorship on Death Rev. 05/2016 American LegalNet, Inc. www.FormsWorkFlow.com (SEAL)