GN-3290, 05/18 Petition for Temporary Guardianship and/or Permanent Guardianship of Minor 24724754.10(1), 54.34, 54.50 and Ch. 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 4 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Name Date of Birth Amended Petition for Temporary Permanent Guardianship of Minor Case No. UNDER OATH, I STATE: 1. I am interested as a relative. I am related to the minor as . a public official. My authority to act as petitioner is . Other: 2. This P etition is filed in the county in which the m inor resides. is physically present. Other: 3. The minor lives in County, State of , mailing address is [Street, City, State, Zip] . 4. The name and mailing address of the person or institution, if any, that has care and custody of the minor or the facility, if any, that is providing care to the minor is: Name Phone Number Mailing Address [Street, City, State, Zip] This Petition for Guardianship is filed with a Petition for Protective P lacement prior to transfer of the minor directly from a hospital to a nursing facility or community - based residential fac i lity under 24750.06, Wis. Stat s. 5. Minor has previously been adopted? Yes No 6. Minor is not may be is subject to the federal Indian Child Welfare Act (ICWA). Tribe/address: (If the minor is/may be subject to 7. The names and mailing addresses of all interested part ies (including the petitioner) and all others entitled to notice are as follows: See attached Name Relationship Mailing Address [Street, City, State, Zip] 8 . The minor, if married, does do es not have children who are not of the current marriage. 9 . This P etition is made in the best interests of the minor. The minor needs a guardian because: 10. I am not aware of a guardianship or other related proceeding or ordered proceeding involving the minor in ano ther state or county. aware of a guardianship or other related proceeding or ordered proceeding involving the minor in American LegalNet, Inc. www.FormsWorkFlow.com GN-3290, 05/18 Petition for Temporary Guardianship and/or Permanent Guardianship of Minor 24724754.10(1), 54.34, 54.50 and Ch. 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 4 another state or county. The details of the guardianship, or other related proceedings of which I am aware are as follows: guardian(s) appointed in Wisconsin: [Name and county where appointed] guardian(s) appointed out - of - state: [ Name and state where appointed ] 11. I nominate the following: See attached Type of Guardian Name Mailing Address [Street, City, State, Zip] Telephone Number Guardian of the Person Guardian of the Estate Temporary Guardian of the Person Temporary Guardian of the Estate Standby Guardian of the Person Standby Guardian of the Estate One or both of the parents of the minor have not been nominated as guardian because: 12 . A sworn and notarized Statement of Acts by Propose d Guardian and Consent to Serve accompanies this P etition. will be filed at least 96 hours before the hearing. will be provided, if required by the court for temporary guardianship. 1 3 . A . See attached General Description Amounts General Description Amounts Cash/Bank Accounts : $ Other Liquid Assets: $ Real E state: $ Other Assets : $ B. Assets of minor previously derived from or benefits of minor now due and payable from U.S. Department of Veterans Affairs are: none See attached C. The minor receives public benefits, including medical assistance; SSI, SSDI or long term community options program benefits: No Yes, type and amount: D. Any other claim, income, compensation, pension, insurance or allowance to which the minor may be entitled is none. as follows: See attached General Description Amounts [Monthly] General Description Amounts [Monthly] Social S ecurity : $ Investment Income : $ Child Support : $ Other : $ Disability : $ Other : $ 14 . I request the court order payment of child support. See attached FOR PERMANENT GUARDIANSHIP 15 . GUARDIAN OF THE PERSON Powers to be transferred to Guardian of the Person in full or in part. I recommend the court find that it is in the best interest of the minor to appoint a permanent guardian of the person to exercise the powers in full or part to 1.A. give informed consent to the voluntary receipt by the minor of a medical examination, medication, including any appropriate psychotropic medication, and medical treatment that is in the minor's best interest, if the guardian has first made a good - faith attempt to discuss with the mino r the voluntary receipt of the examination, medication, or treatment and if the minor does not protest. Full Transfer. Partial Transfer. The minor retains the power to: 1.B. give informed consent, if in the minor's best interests, to the involuntary administration of a medical examination, medication other than psychotropic medication, and medical treatment that is in the minor 's best interest. Full Transfer. Partial Transfer. The minor retains the power to: 2. American LegalNet, Inc. www.FormsWorkFlow.com GN-3290, 05/18 Petition for Temporary Guardianship and/or Permanent Guardianship of Minor 24724754.10(1), 54.34, 54.50 and Ch. 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 4 the minor , or others if minimal risk of harm. Full Transfer. Partial Transfer. The minor retains the power to: 3. authorize minor minor but might help others if greater than minimal risk of harm to the minor but evidence indicates minor would have elected to participate. Full Transfer. Partial Transfer. The minor retains the power to: 4. consent to experimental treatment in the minor Full Transfer. Partial Transfer. The minor retains the power to: 5. give informed consent to receipt by minor of social and supported living services. Full Transfer. Partial Transfer. The minor 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 minor retains the power to: 7. make decisions related to mobility and travel. Full Transfer. Partial Transfer. The minor retains the power to: 8. choose providers of medical, social, and supported living services. Full Transfer. Partial Transfer. The minor retains the power to: 9. make decisions regarding educational and vocational placement and support services or employment. Full Transfer. Partial Transfer. The minor retains the power to: 10. make decisions regarding initiating a petition for termination of marriage. Full Transfer. Partial Transfer. The minor retains the power to: 11. receive all notices on behalf of t he minor. Full Transfer. Partial Transfer. The minor retains the power to: 12. act in all proceedings as an advocate of the minor , except the power to enter into a contract that binds the minor or the minor minor in any legal proceedings pertaining to the property, unless the guardian of the person is also the guardian of the estate. Full Transfer. Partial Transfer. The minor retains the power to: 13. apply for protective placement or for commitment on behalf of the minor which does not require court approval . Full Transfer. Partial Transfer. The minor retains the power to: 14. have care, custody and control of the minor. Full Transfer. Partial Transfer. The minor retains the power to: 15. Other: See attached 16. GUARDIAN OF THE ESTATE I request that the court A. a ppoint a 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: (Choo se one) (1) The minor 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 transferred to guardian. B. authorize the guardian of the estate of the minor to perform the following additional powers (other than to make gifts) that require court approval under 24754.20(2), Wis. St