GN-3380, 11/18 Order on Petition for Appointment of Conservator 24754.76, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Name Date of Birth Amended Order on Petition for Appointment of Conservator Case No. A Petition for Appointment of Conservator was filed and a hearing was held on [Date] . After consideration of the reports and other documents on file, all factors required by the statutes, and such additional information presented; THE COURT FINDS: 1. JURISDICTION, VENUE, AND NOTICE A. This court does does not have jurisdiction over the subject matter and the individual. B. This court is is not a proper venue. C. Notice was was not properly served. 2. THE COURT is is not satisfied that A. the petitioner who is an adult resident of this county is unwilling or believes that he or she is unable to properly manage his or her assets or income and has voluntarily applied to the court for the appointment of a conservator of the estate; and B. the fiduciary and any standby conservator are suitable, and C. other statutory requirements for appointment of a conservator have been met. 3. CONSERVATOR It is appropriate to A. appoint and authorize a permanent conservator to perform the duties of a guardian under 24754.19, Wis. Stats., and exercise the powers that do not require court approval under 24754.20(3), Wis. Stats. B. authorize the conservator to perform the following additional powers [other than to make gifts] that require court approval under 24754.20(2), Wis. Stats.: . C. direct the conservator bank, credit union, savings bank or savings and loan association in the name of the conservator and the individual, payable only upon further order of the court. 4. The petitioner has executed a Financial Durable Power of Attorney. Good cause exists to revoke limit the Durable Financial Power of Attorney because: . 5. SUITABILITY OF CONSERVATOR The following person(s) or organization is/are suitable to be appointed: American LegalNet, Inc. www.FormsWorkFlow.com GN-3380, 11/18 Order on Petition for Appointment of Conservator 24754.76, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 Type of Conservator Name Mailing Address [Street, City, State, Zip] Telep hone Number Conservator Standby Conservator THE COURT ORDERS: The Petition is dismissed for the following reason(s): . granted as follows: 1. POWER OF ATTORNEY The Financial Durable Power of Attorney remains in effect. is revoked. is limited as follows: . See attached 2. APPOINTMENT OF CONSERVATOR The court appoints the following: Type of Conservator Name Mailing Address [Street, City, State, Zip] Telephone Number Conservator Standby Conservator 3. LIMITATIONS AND POWERS The conservator is authorized to exercise powers in full or in part consistent with the above findings in a manner that is appropriate to the individual and that constitutes the least restrictive form of intervention. 4. BOND The conservator will be issued Letters of C onservatorship upon filing surety bond signature bond in the amount of $ . is not required to file a bond if the conservator deposits the individual funds of $100,000 or less in an insured account of a bank, credit union, savings bank or savings and loan association in the name of the conservator and the individual, and payable only upon further order of the court. Proof of deposit shall be filed with the court within days. is not required to file a bond and bond is waived. Other: See attached 5. CONSENT TO SERVE Letters of Conservatorship shall be issued upon filing Consent to Serve and any required bond. 6. INVENTORY AND ANNUAL ACCOUNT A. The conservator shall file an inventory of the individualassets within 60 days. and provide a copy of the inventory to the following persons: . B. The conservator shall file an account by April 15 of each year or as otherwise required by the court as follows: . 7. CHANGE OF ADDRESS The conservator shall immediately notify the court in writing of any change in the address of the individual or of the conservator. 8. COMPENSATION AND REIMBURSEMENT payment is made. THIS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL IF SIGNED BY A CIRCUIT COURT JUDGE. American LegalNet, Inc. www.FormsWorkFlow.com