STATE OF VERMONT SUPERIOR COURT Unit In re Guardianship of : PROBATE DIVISION Docket No.: MOTION TO TERMINATE or MODIFY ADULT GUARDIANSHIP I, _________________________________________ request that the court: (check one) Name of Petitioner Terminate the guardianship of the respondent. Modify the guardianship of the respondent as follows: . In support of this request, I state: 1. My relationship to the Respondent is: _____________________________________________ 2. By order of this Court dated _________________________________, the Court appointed Date of Order __________________________________________ with the following guardianship powers: Name of Guardian Check all that apply to have general supervision over the Respondent, including care, habilitation, education, employment and choosing or changing where the Respondent lives, subject to the requirements of 14 V.S. A. §§2691, 3073 and 3074; to seek, approve or refuse medical or dental treatment, subject to the provisions of 14 V.S.A. §3075 and any constitutional right of the Respondent to refuse treatment; to supervise Respondent's income and resources; to approve or withhold approval of any contract Respondent wishes to make, except a contract for basic needs; to approve or withhold approval of the sale, lease or encumbrance of Respondent's real property subject to the provisions of 14 V.S.A. §2881 ­ 2891; to seek legal advice and to start or defend against a court action in Respondent's name. PAG99 ­ Motion to Terminate or Modify Adult Guardianship (09/2014) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 1. The reasons for my request are as follows: Briefly describe the reasons why the guardianship should be modified or terminated. Dated Signature of Petitioner Petitioner's Name Printed Petitioner's Address Petitioner's Phone Number PAG99 ­ Motion to Terminate or Modify Adult Guardianship (09/2014) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com