) IN CIRCUIT COURT ) COUNTY OF _________________ ) __________ JUDICIAL CIRCUIT ) ************************************************************************************ ) In the Matter of the Guardianship of ) ____GDN________________ ) ______________________________, ) PETITION TO TERMINATE GUARDIANSHIP ) ON DEATH OF PROTECTED PERSON a Protected Person. ) ) ************************************************************************************ I, __________________________ , Guardian for the above-named Protected Person, being duly sworn upon oath, state and affirm the following: I was appointed guardian of the above-named Protected Person on _______________ (month), _____ (day), __________ (year). This guardianship 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 is attached per SDCL 29A-5-403(4). I request the Court enter an Order Terminating the Guardianship and Order Approving the Guardian's Final Report, and that Letters of Guardianship be revoked (and any bond released). Dated ______________ ___ , ________ (month) (day) (year) STATE OF SOUTH DAKOTA ____________________________________ Guardian'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-157 Petition to Terminate Guardianship on Death of Protected Person Rev. 05/2016 American LegalNet, Inc. www.FormsWorkFlow.com