GN-3904, 02/19 Petition to Accept Guardianship Transferred to Wisconsin 24724753.32, 54.34 and 54.38(1) & (2 ), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Name Date of Birth Petition to A ccept Guardianship Transferred to Wisconsin Case No. UNDER OATH, I STATE : 1. I am the guardian of the person estate of the above - named individual subject to guardianship in the State of [ original state] . I am petitioning the court to accept guardianship transferred from another state and appoint me as guardian under the laws of Wisconsin. 2. The individual lives in County, State of , and the individual subject to guardianship mailing address is [Street, City, State, Zip] . 3. The individual subject to guardianship is expected to move permanently to Wisconsin and will reside at the foll owing address: [include facility name if applicable] 4 . The names and mailing addresses of all interested parties (including the petitioner) and all others ent itled to notice are as follows: See attached Name Relationship Mailing Address [Street, City, State, Zip] 5 . I am eligible for appointment in Wisconsin to serve as guardian of the person estate. 6. I am filing with this Petition, copies of the following documents: certified copy of the other state's provisional order of transfer. proposed order specifying the powers to be granted in this state . s worn statement that, to the best of my knowledge, the proposed order is consistent with the authority granted to me by the original court. I REQUEST THE COURT : 1. Set a hearing, if required. 2. Appoint a guardian ad litem, if required, or if there is an objection to the transfer. 3. After notice to interested persons and any required hearing, enter a P rovisional O rder on Petition to Transfer Guardianship. 4. Upon receipt of the provisional o rder approving the transfer of g uardianship to Wisconsin from another state , enter a Final Order Accepting G uardianship Transferred to Wisconsin and appoint me as the guardian of person estate with the authority stated in the attached proposed f inal order . 5. Other: State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Signature Name Printed or Typed Address Address Phone Number American LegalNet, Inc. www.FormsWorkFlow.com