GN-3655, 05/18 Petition for Modification of Guardianship 24754.64, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Name Date of Birth Amended Petition for Modification of Guardianship Case No. UNDER OATH, I STATE: 1. I am the ward who is 18 years of age or older. a person acting on the behalf . the Guardian of Person. Guardian of Estate. 2. This is a Petition to have the guardianship limited and specific rights restored. 3. This Petition is filed more than 180 days after any previous hearing on the Petition for Guardianship or Petition for Receipt and Acceptance of a Foreign Guardianship, or there are exigent circumstances, including presentation of new evidence, that require a review at any time. [Specify circumstances] . 4. At a hearing held on [Date] , the ward was determined to be incompetent and in need of a guardian in Wisconsin. [County] out-of-state. [State where determined] (Certified copy of order is attached) 5. A Report of Examination of Ward by a Physician or Psychologist is filed with this Petition or will be filed at this hearing. 6. I believe the court should modify the guardianship of the person as follows: A. Rights to be restored in full. These rights were previously removed from the ward and should be restored to the ward. Due to the prior removal, no one is able to exercise the right. Right to be restored in full to (1) execute a will. (2) serve on a jury. (3) register to vote or to vote in an election. B. Rights to be restored, removed in full, or exercised by ward only with consent of guardian of person. The ward has the incapacity or limited capacity to exercise the following rights to: (If any box is not checked for a right, the ward retains that right in full.) Ward may not exercise this right. Remove right in full. Ward 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 full or in part to 1. A. give informed consent to the voluntary receipt by the ward of a medical examination, medication, including any appropriate psychotropic medication, and medical treatment that is in the ward best interest, if the guardian has first made a good - faith attempt to discuss with the ward the voluntary receipt of the examination, medi cation, or treatment and if the ward does not protest. Full Transfer. Partial Transfer. The ward retains the power to: American LegalNet, Inc. www.FormsWorkFlow.com GN-3655, 05/18 Petition for Modification of Guardianship 24754.64, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 See attached 7. GUARDIAN OF THE ESTATE I believe the court should modify the guardianship of the estate as follows: A. appoint 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: (Choose one) (1) The ward 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 to perform the following additional powers (other than to make gifts) that require court approval under 24754.20(2), Wis. Stats.: See attached 1. B. give informed consent, if in ward best interests, to the involuntary administration of a medical examination, medication other than psychotropic medication, a nd medical treatment that is in ward best interest. Full Transfer. Partial Transfer. The ward retains the power to: 2. authorize ward research project might help the ward , or others if minimal risk of harm. Full Transfer. Partial Transfer. The ward retains the power to: 3. authorize ward esearch that might not help the ward but might help others if greater t han minimal risk of harm to the ward but evidence indicates ward would have elected t o participate. Full Transfer. Partial Transfer. The ward retains the power to: 4. consent to experimental treatment in the ward Full Transfer. Partial Transfer. The ward retains the power to: 5. give informed consent to receipt by ward of social and supported living services. Full Transfer. Partial Transfer. The ward 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 ward retains the power to: 7. make decisions related to mobility and travel. Full Transfer. Partial Transfer. The ward retains the power to: 8. choose providers of medical, social, and supported living services. Full Transfer. Partial Transfer. The ward retains the power to: 9. make decisions regarding educational and vocational placement and support services or employment. Full Transfer. Partial Transfer. The ward retains the power to: 10. make decisions regarding initiating a petition for termination of marriage. Full Transfer. Partial Transfer. The ward retains the power to: 11. receive all notices on behalf of ward. Full Transfer. Partial Transfer. The ward retains the power to: 12. act in all proceedings as an advocate of the ward , except the power to enter into a contract that binds the ward or the ward ward in any legal proceedings perta ini ng to the property, unless the g uardian of the p erson is also the g uardian of the e state. Full Transfer. Partial Transfer. The ward retains the power to: 13. apply for protective placement or for commitment on behalf of ward which does not require court approval . Full Transfer. Partial Transfer. The ward retains the power to: 14. have custody of the ward . Full Transfer. Partial Transfer. The ward retains the power to: 15. Other: American LegalNet, Inc. www.FormsWorkFlow.com GN-3655, 05/18 Petition for Modification of Guardianship 24754.64, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 C. deposit the wardsavings and loan association in the name of the guardian and the ward, payable only upon further order of the court, and waive bond for the guardian of the estate. 8. ALTERNATIVE TO GUARDIANSHIP OF ESTATE FOR SMALL ESTATES I request the court dispense with the guardian of the estate and transfer the funds of $50,000 or less according to one of the alternatives for small estates under 24754.12(1), Wis. Stats., as follows: . See attached I REQUEST THE COURT: 1. Order a hearing on this Petition. 2. Designate persons entitled to notice of hearing and the manner in which notice shall be given. 3. Limit the guardianship of person and restore specific rights. 4. Limit the guardianship of estate and restore specific rights. 5. Award appropriate fees and costs. 6. Other: State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Petitioner Name Printed or Typed Street Address City, State, Zip Date American LegalNet, Inc. www.FormsWorkFlow.com