GN-3170, 05/19 Determination and Order on Petition for Guardianship Due to Incompetency 24724753.23, 54.10(3), 54.47, 54.74, Chapter 46 and 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 6 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Name Date of Birth Amended Determination and Order on Petition for Guardianship Due to Incompetency Case No. A Petition for Guardianship Due to Incompetency 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, NOTICE, APPEARANCES AND EVALUATIONS TO COURT 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. D. The individual is present. Other: E. The proposed guardian and any proposed standby guardian are present as follows: not present and the court permits attendance by telephone for good cause shown as follows: not present and the court excuses the attendance as follows: F. Additional evaluations are not necessary. 2. CAPACITY AND NEED FOR GUARDIANSHIP Upon presentation of clear and convincing evidence, the individual is not incompetent. advanced planning by the individual renders guardianship unnecessary. the elements of the petition are unproven. the application for appointment of a conservator by the individual un der 24754.76, Wis. Stats., is appropriate. the individual was adjudicated incompetent in another jurisdiction and a petition for receipt and acceptance of a foreign guardianship was granted. The individual is a minor who has attained age 14 and is developmentally disabled. The individual is found to be incompetent because A. the individual is at least 17 years and 9 months of age; AND B. the individual is impaired as a result of American LegalNet, Inc. www.FormsWorkFlow.com GN-3170, 05/19 Determination and Order on Petition for Guardianship Due to Incompetency 24724753.23, 54.10(3), 54.47, 54.74, Chapter 46 and 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 6 a developmental disability. degenerative brain disorder. serious and persistent mental illness. other like incapacities. AND C. - making or communication is unable to be met effectively and less restrictively through appropriate and reasonably available training, education, support services, health care, assistive devices, or other means that the individual will accept. D. (For appointment of guardian of the person ) the individual, because of impairment, is unable effectively to receive and evaluate information or to make or communicate decisions to such extent that the individual is unable to meet the essential E. (For appointment of guardian of the estate ) the individual, because of an impairment, is unable effectively to receive and evaluate information or to make or communicate decisions related the extent that at least one of the following applies: (1) The individual has property that will be dissipated in whole or in part; o r (2) The individual is unable to provide for (3) The individual is unable to prevent financial exploitation. 3. GUARDIAN OF THE PERSON The individual is in need of a guardian of the person. A. Rights to be removed in full. If removed, these rights may not be exercised by any person. The individual has the incapacity to exercise the right to (1) execute a will. (2) serve on a jury. (3) register to vote or to vote in an election. B. Rights to be removed in full or exercised by individual only with consent of guardian of person. The individual has incapacity or limited capacity to exercise the following rights: (If any box is not checked the individual retains that right in full.) Individual may not exercise this right. Remove right in full. Individual may exercise only with the consent of the Guardian of the Person. (1) consent to marriage. (3) apply for a fishing license. (4) apply for a license under Ch. 29, Wis. Stats., other than fishing. (5) apply for any other license or credential under 24754.25(2)(c)1.d., Wis. Stats. Specifically: (6) consent to sterilization. (7) consent to organ, tissue, or bone marrow donation. C. Powers to be transferred to guardian of the person in part or in full. The court transfers to the guardian of the person the power to exercise in full or in part to 1.A. give informed consent to the voluntary receipt by the individual of a medical examination, medication, including any appropriate psychotropic medication, and medical treatment that is in th e individual 's best interest, if the guardian has first made a good - faith attempt to discuss with the individual the voluntary receipt of the examination, medication, or treatment and if the individual does not protest. Full Transfer. Partial Transfer. The individual retains the power to: 1.B. give informed consent, if in the individual 's best interests, to the involuntary administration of a medical examination, medication other than psychotropic medication, and medical treatmen t. Full Transfer. Partial Transfer. The individual retains the power to: 2. might help the individual or others if minimal risk of harm. Full Transfer. Partial Transfer. The individual retains the power to: 3. if greater than minimal risk of harm to the individual but evidence indicates individual would have elected to participate. Full Transfer. Partial Transfer. The individual retains the power to: 4. American LegalNet, Inc. www.FormsWorkFlow.com GN-3170, 05/19 Determination and Order on Petition for Guardianship Due to Incompetency 24724753.23, 54.10(3), 54.47, 54.74, Chapter 46 and 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 6 Full Transfer. Partial Transfer. The individual retains the power to: 5 . give informed consent to receipt by individual of social and supported living services. Full Transfer. Partial Transfer. The individual retains the power to: 6. give informed consent to release of confidential records other than court, treatment, and patient health care records and redisclosure as appropriate. Full Transfer. Partial Transfer. The individual retains the power to: 7. make decisions related to mobility and travel. Full Transfer. Partial Transfer. The individual retains the power to: 8. choose providers of medical, social, and supported living services. Full Transfer. Partial Transfer. The individual retains the power to: 9. make decisions regarding educational and vocational placement and support services or employment. Full Transfer. Partial Transfer. The individual retains the power to: 10. make decisions regarding initiating a petition for termination of marriage. Full Transfer. Partial Transfer. The individual retains the power to: 11. receive all notices on behalf of the individual. Full Transfer. Partial Transfer. The individual retains the power to: 12. act in all proceedings as an advocate of the individual, except the power to enter into a contract that legal proceeding pertaining to the property, unless the guardian of the person is also the guardian of the estate. Full Transfer. Partial Transfer. The individual retains the power to: 13. apply for protective placement or for commitment on behalf of the individual which does not require court approval . Full Transfer. Partial Transfer. The individual retains the power to: 14. have custody of the individual. Full Transfer. Partial Transfer. The individual retains the power to: 15. Other: See attached 4. GUARDIAN OF THE ESTATE It is appropriate to A. appoint and authorize a permanent guardian of the estate to perform duties under 24754.19, Wis. Stats., and exercise the powers that do not require court approval under 24754.20(3), Wis. Stats., except as follows: (Choose one) (1) The individual retains all powers, except for the following powers to be transferred to the guardian: . (2) All powers to be transferred to the guardian, except for the following powers: . (3) All powers to be