) IN CIRCUIT COURT ) COUNTY OF _________________ ) __________ JUDICIAL CIRCUIT ) ************************************************************************************ In the Matter of the Guardianship and ) ____GDN________________ ) Conservatorship of ____________________, ) PETITION TO TERMINATE ) GUARDIANSHIP & CONSERVATORSHIP a Protected Person. ) ON DEATH OF PROTECTED PERSON ************************************************************************************ I, __________________________ , Guardian-Conservator for the above-mentioned Protected Person, being duly sworn upon oath, state and affirm the following: I was appointed guardian and conservator of the above-mentioned Protected Person on _______________ (month), _____ (day), __________ (year). This guardianship and conservatorship has since terminated when the Protected Person 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 Guardian's Final Report and a Conservator's Final Accounting is also attached per SDCL 29A-5-403(4), and 29A-5-408(4). I request the Court enter an Order Terminating the Guardianship/Conservatorship and Order Accepting the Final Report and Final Accounting (if applicable), and that Letters of Guardianship/Conservatorship be revoked (and any bond released). Dated ______________ ___ , ________ (month) (day) (year) STATE OF SOUTH DAKOTA ____________________________________ Guardian-Conservator's Signature (Sign only in front of Notary or Clerk) ____________________________________ Mailing Address ____________________________________ City, State, and Zip Code ____________________________________ Phone Number ____________________________________ E-mail Address Sworn/affirmed before me this _____ day of __________________, 20____. _____________________________________ (Notary Public / Clerk of Courts) If Notary, my commission expires: ______________ (SEAL) UJS-159 Petition to Terminate Guardianship & Conservatorship on Death of Protected Person Rev. 05/2016 American LegalNet, Inc. www.FormsWorkFlow.com