GN-3901, 02/19 Petition to Transfer Guardianship to Another State 24724753.31(1-3) 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 Transfer Guardianship to Another State Case No. UNDER OATH, I STATE : 1. I am the guardian of the person estate of the above - named individual subject to guardianship . I am petitioning to transfer the guardianship t o another state, specifically the State of [r eceiving state] . 2. The individual subject to guardianship 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 the State of [r eceiving state] and will reside at the following address: (include facility name if applicable) . 4 . The names and mailing addresses of all interested parties (including the petitioner) and all others entitled to notice are as follows: See attached Name Relationship Mailing Address [Street, City, State, Zip] I REQUEST THE COURT : 1. Set a hearing, if required . 2. Appoint a guardian ad litem , if required, or if there is an objec tion to the transfer . 3. After notice to interested persons and any required hearing, enter a provisional order approving the transfer of guardianship to another state. 4. Upon receipt of a provisional order accepting the transfer from the other state, and such other terminating documents as required, enter a final order transferring guardianship to another state. 5. Upon receipt of a final order accepting the transfer from th e other state, transmit the guardians hip file to the receiving court and discharge the Wisconsin guardian. 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: Signature Name Printed or Typed Address Address Phone Number American LegalNet, Inc. www.FormsWorkFlow.com