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Order On Petition For Review And Modification Or Termination Of Guardianship Form. This is a Wisconsin form and can be use in Circuit Court Statewide.
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Tags: Order On Petition For Review And Modification Or Termination Of Guardianship, GN-3660, Wisconsin Statewide, Circuit Court
FORM SUMMARY
______________________________________________________________________________
Name of Form:
Order on Petition for Review and Modification or Termination
of Guardianship
Form Number:
GN-3660
______________________________________________________________________________
Statutory Reference:
§54.64, Wisconsin Statutes
Benchbook Reference:
GA-1, GA-2
Purpose of Form:
Order on petition to review or modify a guardianship.
Who Completes It:
Petitioner or attorney.
Distribution of Form:
Original to court.
Accompanying Forms:
New Form/Modification:
Modified; last update 10/07.
Modifications:
Added Wamboldt language. Updated powers section per 2007 WI
Act 45.
Comments:
About this Form:
This form is the product of the Wisconsin Records Management
Committee, a committee of the Director of State Court's Office
and a mandate of the Wisconsin Judicial Conference.
If you have additional information that does not change the
meaning of the form, attach it on a separate page. The form
itself shall not be altered.
Date: 04/24/2008
Page 1
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For Official Use
COUNTY
STATE OF WISCONSIN, CIRCUIT COURT,
Amended
IN THE MATTER OF
Order on Petition for
Review and Modification or
Termination of Guardianship
Case No.
Date of Birth
This matter is before the court on a Petition for Review and Modification or Termination of Guardianship and a
hearing has been held. The court has considered the testimony, other relevant evidence presented, and the
guardian ad litem’s report and recommendation.
THE COURT FINDS:
1. NOTICE AND JURISDICTION
has not
has
A. Notice
does not have
has
B. This court
individual.
been properly served.
jurisdiction of the subject matter and of the person of the
2. PETITION FOR REVIEW INCOMPETENCY
A. The petition requests a review of incompetency.
B. The ward:
continues to be incompetent and guardianship continues to be necessary.
is no longer incompetent.
3. PETITION TO DISCHARGE GUARDIAN AND APPOINT SUCCESSOR GUARDIAN:
as:
A. The petition requests discharge of: (name)
guardian of person
guardian of estate
and a successor guardian appointed.
B. This request:
should not be granted for the following reason:
should be granted.
1. A reasonable effort was made to question the ward and the ward indicated:
no preference for the successor guardian.
that the ward prefers:
guardian of person.
to serve as
guardian of estate.
to serve as
2. Based upon the Statement of Acts and Consent to Serve submitted by the proposed guardian and
recommendation of the guardian ad litem, the following person or organization is competent and
suitable to be appointed as successor guardian:
Type of Guardian
Guardian of the
Guardian of the
Temporary Guardian of the
Temporary Guardian of the
Standby Guardian of the
Standby Guardian of the
Name and Address
Phone
Person
Estate
Person
Estate
Person
Estate
4. PETITION TO LIMIT AUTHORITY OF GUARDIAN OF PERSON AND RESTORE SPECIFIC RIGHTS
GN-3660, 04/08 Order on Petition for Review and Modification or Termination of Guardianship
This form shall not be modified. It may be supplemented with additional material.
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§54.64, Wisconsin Statutes
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a. The petition requests that the authority of the guardian of person be limited and that specific rights be
restored to the ward.
b. This request:
should not be granted. The ward has not regained capacity to exercise the specific rights requested
to be restored.
should be granted. The ward has regained capacity to exercise specific rights. The rights and
powers as previously determined are modified to be as follows:
(CAUTION: The boxes checked below should reflect the original order, any subsequent orders AND the
changes resulting from this order so that it is not necessary to view multiple documents to determine the
current rights and powers of the guardian and ward. If a right is restored, the box should not be checked.)
A. Rights to be removed in full. If removed, these rights may not be exercised by any person.
The individual has incapacity to exercise one or more of the following rights and such right should be
removed:
1. Right to execute a will.
2. Right to serve on a jury.
3. Right to register to vote or to vote in an election.
B. Rights to be removed or exercised by individual with consent of Guardian of Person. If
removed, these rights may not be exercised by any person. If a right is to be affected, the box
to the far left must be marked. Marking only box (1) or (2) has no effect and the individual
retains the right.
The individual has incapacity to exercise one or more of the following rights and such right should be
removed or the individual retains the right to exercise the right only with consent of the guardian of the
person.
a. Right to consent to marriage:
Choose (1) or (2):
(1) the individual has incapacity to exercise this right.
(2) the individual retain the right to exercise this right only with consent of the guardian of
the person.
b. Right to apply for an operator’s license, a hunting, fishing or other license issued under ch. 29,
.
or a credential as defined in §440.01(2), Wisconsin Statutes:
Choose (1) or (2):
(1) the individual has incapacity to exercise this right.
(2) the individual retain the right to exercise this right only with consent of the guardian of
the person.
c. Right to consent to sterilization.
Choose (1) or (2):
(1) the individual has incapacity to exercise this right.
(2) the individual retain the right to exercise this right only with consent of the guardian of
the person.
d. Right to consent to organ, tissue, or bone marrow donation.
Choose (1) or (2):
(1) the individual has incapacity to exercise this right.
(2) the individual retain the right to exercise this right only with consent of the guardian of
the person.
C. Powers to be transferred to Guardian of the Person in part or in full.
If a power is to be affected, the box to the far left must be marked. Marking only box (1) or (2)
has no effect and the individual retains the power.
1) I request the court to appoint a permanent guardian of the person.
2) The individual lacks evaluative capacity in part or in full to exercise specific powers requested to
be transferred to the guardian as follows:
ab. Except as otherwise limited by Wisconsin Statute 54.25(2)(d)2.ab., the power to give an
informed consent to the voluntary receipt by the guardian's ward of a medical examination,
medication, including any appropriate psychotropic medication, and medical treatment that
is in the ward's best interest, if the guardian has first made a good-faith attempt to discuss
GN-3660, 04/08 Order on Petition for Review and Modification or Termination of Guardianship
This form shall not be modified. It may be supplemented with additional material.
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with the ward the voluntary receipt of the examination, medication, or treatment and if the
ward does not protest.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
ac. Except as otherwise limited by Wisconsin Statute 54.25(2)(d)2.ac., the power to give
informed consent, if in the ward's best interests, to the involuntary administration of a
medical examination, medication other than psychotropic medication, and medical treatment
that is in the ward's best interest.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
b. The power to authorize individual’s participation in an accredited or certified research
project if the research project might help the individual, or others if minimal risk of harm.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
c. The power to authorize individual’s participation in research that might not help the
individual but might help others if greater than minimal risk of harm to the individual but
evidence indicates individual would have elected to participate.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
d. The power to consent to experimental treatment in the individual’s best interests.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
e. The power to give informed consent to receipt by individual of social and supported living
services.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
f.
The power to give informed consent to release of confidential records other than court,
treatment, and patient health care records and redisclosure as appropriate.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
g. The power to make decisions related to mobility and travel.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
GN-3660, 04/08 Order on Petition for Review and Modification or Termination of Guardianship
This form shall not be modified. It may be supplemented with additional material.
Page 3 of 6
.
.
.
.
.
.
.
.
§54.64, Wisconsin Statutes
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Case No.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
h.
[Intentionally omitted to correspond with statute.]
i.
The power to choose providers of medical, social, and supported living services.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
j. The power to make decisions regarding educational and vocational placement and support
services or employment.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
k. The power to make decisions regarding initiating a petition for termination of marriage.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
l. The power to receive all notices on behalf of individual.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
m. The power to act in all proceedings as an advocate of the individual, except the power to enter
into a contract that binds the individual or the individual’s property or to represent the
individual in any legal proceedings pertaining to the property, unless the guardian of the
person is also the guardian of the estate.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
n. The power to apply for protective placement or for commitment.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
o. The power to have custody of the individual, if an adult, and the power to have care, custody,
and control of the individual, if a minor.
Choose (1) or (2):
(1) Individual retains limited capacity and the power to:
Guardian of the person to exercise power not retained by individual.
(2) Individual lacks evaluative capacity in full. Guardian of the person to exercise full
power.
p. other specific powers:
See attached
.
.
.
.
.
.
.
5. PETITION TO LIMIT AUTHORITY OF GUARDIAN OF ESTATE AND RESTORE SPECIFIC POWERS
A. The petition requests that the authority of the guardian of estate be limited and that specific powers be
restored to the ward.
GN-3660, 04/08 Order on Petition for Review and Modification or Termination of Guardianship
This form shall not be modified. It may be supplemented with additional material.
Page 4 of 6
§54.64, Wisconsin Statutes
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Case No.
B. This request:
should not be granted. The ward has not regained capacity to exercise the specific powers
requested to be restored.
should be granted. The ward has regained capacity to exercise specific powers. The powers as
previously determined are modified to be as follows:
(CAUTION: The boxes checked below should reflect the original order, any subsequent orders AND the
changes resulting from this order so that it is not necessary to view multiple documents to determine the
current rights and powers of the guardian and ward. If a right is restored, the box should not be checked.)
Choose one:
(1) Most authority retained by ward, limited authority transferred to guardian:
Individual retains evaluative capacity except for the ability to perform a duty or exercise a power
which is to be transferred to the guardian of the estate as follows:
(2) Limited authority retained by ward, most authority transferred to guardian:
Individual retains limited evaluative capacity and should retain the ability to perform a duty or
exercise a power as follows:
Guardian of the estate is to perform the duties of a guardian of the estate under §54.19, and
exercise the powers that do not require court approval under §54.20(3), except as retained by
individual.
(3) Full authority transferred to guardian:
Individual lacks evaluative capacity in full. Guardian of the estate is requested to perform the
duties of a guardian of the estate under §54.19, and exercise the powers that do not require
court approval under §54.20(3).
6.
.
PETITION TO TERMINATE GUARDIANSHIP OF PERSON
A. The petitioner requests termination of guardianship of person.
B. This request:
should not be granted for the following reason:
should be granted. There is a basis for terminating guardianship of the person, as follows:
1. Based upon the petition that requests the court to adjudicate the ward formerly found to
be incompetent to be no longer incompetent.
2. The ward found to be incompetent, has married a person who is not subject to a
guardianship.
3. The ward has changed residence from this state to another state and a guardian has
been appointed in the new state of residence.
4. The formerly minor ward, attained age 18, unless the guardianship was ordered on the
grounds of incompetency.
5. The minor ward whose guardianship was not ordered on the grounds of incompetency,
has married.
6. The ward died.
7.
.
PETITION TO TERMINATE GUARDIANSHIP OF ESTATE
A. The petition requests termination of guardianship of estate.
B. This request:
should not be granted for the following reason:
should be granted. There is a basis for terminating guardianship of the estate as follows:
1. Based upon petition that requests the court to adjudicate the ward formerly found to be
incompetent to be no longer incompetent.
2. The ward has changed residence from this state to another state and a guardian has
been appointed in the new state of residence.
3. The formerly minor ward attained age 18.
4. The minor ward whose guardianship was not ordered on the grounds of incompetency
has married.
5. The ward died and the estate was not terminated by summary settlement of small estate.
GN-3660, 04/08 Order on Petition for Review and Modification or Termination of Guardianship
This form shall not be modified. It may be supplemented with additional material.
Page 5 of 6
§54.64, Wisconsin Statutes
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Order on Petition for Review and Modification or Termination of Guardianship
8.
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PETITION TO DISPENSE WITH DEPLETED GUARDIANSHIP OF ESTATE
A. The petition requests dispensing with guardianship of estate under $50,000 and disposing of the
income and assets of the ward as follows:
.
B. This request:
should not be granted for the following reason:
should be granted. The income and assets of ward do not exceed $50,000 and are reduced to a
point where it is to the advantage of the ward to dispense with guardianship of estate in the following
manner:
IT IS ORDERED:
1. The petition is denied.
2. The guardianship shall continue.
A. The petition to discharge guardian and appoint successor guardian is granted.
The requested successor guardian of estate is appointed:
with a:
.
signature bond
in the amount of $
surety bond
and is not required to file a bond provided that the successor guardian shall deposit of
ward’s funds of $100,000 or less in an insured account in the name of the guardian
and the ward, and payable only upon further order of the court. Proof of deposit shall
days.
be filed with the court within
and is not required to file a bond and bond is waived.
Upon approval of a final account and receipt for distribution, the guardian of the estate may be
discharged.
B. The petition to limit authority of guardian and restore specific rights is granted. The modified rights
and powers of the ward and guardian are as indicated in the findings above.
estate shall be terminated.
person
3. The guardianship of the
The guardian of person is discharged.
The guardian of estate shall make appropriate financial arrangements for the burial or other disposition
of the remains of the ward.
The guardian of estate shall deliver the property of the nonresident ward to the guardian appointed in
the state of the nonresident ward upon compliance with §54.64(6), Wisconsin Statutes.
4. The petition to dispense with depleted guardianship of estate is granted and the requested disposition of
the income and assets of the ward is approved. Upon approval of a final account and receipt for final
distribution, the guardian of the estate may be discharged.
and is ordered to be
5. Compensation of the guardian ad litem is approved in the amount of $
paid:
from the ward’s income or assets.
by petitioner.
Other:
THIS IS A FINAL JUDGMENT/ORDER FOR PURPOSES OF APPEAL.
Name of Attorney
BY THE COURT:
Address
Circuit Court Judge/Court Commissioner
Telephone Number
Name Printed or Typed
Bar Number
Date
GN-3660, 04/08 Order on Petition for Review and Modification or Termination of Guardianship
This form shall not be modified. It may be supplemented with additional material.
Page 6 of 6
§54.64, Wisconsin Statutes
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