GN-4090, 05/19 Order Appointing Guardian ad Litem (Annual Review of Protective Placement) 247 55.18(2), 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 Appointing Guardian ad Litem (Annual Review of Protective Placement) Case No. THE COURT FINDS: 1. The above - named ward is protectively placed. 2. The above - named ward is currently placed at Address: Name of facility and contact person and phone number (if any) Facility Name: Contact Person Name: Contact Person Phone Number: 3. The name, address and telephone number of (s) is: Name Mailing Address [Street, City, State, Zip] Telephone Number 4. The protective plac ement was last reviewed by the C ourt on [Date of last order] . 5. The county department filed the annual report of the review of the status of this ward and c om munity p lan, if applicable, and the Petition for Annual Review of Protective Placement. THE COURT ORDERS: 1. The appointment of the following attorney to act as guardian ad litem of the above - named ward : Attorney Name Street Address City, State, Zip Phone N umber 2. The guardian ad litem shall: A. review the county ard, the Annual Report on the Condition of the Ward and any other American LegalNet, Inc. www.FormsWorkFlow.com GN-4090, 05/19 Order Appointing Guardian ad Litem (Annual Review of Protective Placement) 24755.18(2), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 B. m of : the procedure for review of protective placement, rights in this proceeding, the contents of the annual report of the review of the status of this w ard by the county department, and a change in or termination of protective p lacement may be ordered by the C ourt. C. r guardian. D. a scertain whether the ward wishes to exercise any of his or her rights. E. f ile the Report and Recommendation of the Guardian ad Litem (Annual Review) within 30 days of this Order, by [ D ate] . 3. Other: DISTRIBUTION: 1. Court 2. Individual/Ward 3. 4. Corporation Counsel 5. 6. Guardian ad litem 7. Care 8. Facility in which the Individual resides 9. County Department of Human Services/Social Worker American LegalNet, Inc. www.FormsWorkFlow.com