JC-1605, 05/18 Petition For Appointment of Guardian/Notice of Hearing 24724748.623(1), 48.831 and 48.977, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF a person under the age of 18 Date of Birth Amended Petition for Appointment of Guardian/Notice of Hearing (Chapter 48) Case No. I STATE ON INFORMATION AND BELIEF: 1 . Child has previously been adopted? Yes No Parent 1 Parent 1 is deceased Parent 2 Parent 2 is deceased 2. These proceedings are are not subject to the Uniform Child Custody Jurisdiction and Enforcement Act. 3. The child is is not may be subject to the federal Indian Child Welfare Act. Tribe/address: 4. The person or agency nominated as the guardian of the child is Address: 5. The appointment of a guardian is being requested for a child in need of protection or services. a. The petitioner is the child. the department. a county department. the person with whom the child is placed or in whose home placement of the child is recommended and who is nominated aetition. the licensed child welfare agency assigned primary responsibility for providing services to the child under a court. a person representing the interests of the public under 24748.09, Wis. Stats. b. The child was adjudicated in need of protection or services under 247 , Wis. Stats., on [Date] and has been placed, or continued in a placement, outside of his or her home pursuant to one or more court orders under 247 , Wis. Stats. c. The facts and circumstances which establish that the conditions specified under 24748.977(2)(b)-(f), Wis. Stats. met are: See attached d. The person nominated as the successor guardian is Address: e. The person representing the interests of the public under 24748.09, Wis. Stats., is f. The agency primarily responsible for providing services to the child under a court order is American LegalNet, Inc. www.FormsWorkFlow.com JC-1605, 05/18 Petition For Appointment of Guardian/Notice of Hearing 24724748.623(1), 48.831 and 48.977, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 g. The department or county department has determined that the proposed guardian is eligible to receive monthly subsidized guardianship payments under 24748.623(1), Wis. Stats., and it is requested that the court confirm those determinations. Attach department eligibility statement. 6. The appointment of guardian is being requested for a child without a living parent. a. The petitioner is a relative or family member of the child. the department. a county department. a person with whom the child has resided who has acted as a parent. a child welfare agency licensed under 247 48.61(5), Wis. Stats., to accept guardianship. a guardian appointed under ch. 54 whose resignation as guardian has been accepted by a court under 24754.54, Wis. Stats. b. Adoption is is not in the best interest of the child. I request that [Name] be appointed guardian of the child. Signature of Petitioner Name Printed or Typed Date This case is scheduled for a hearing as scheduled below: NOTICE OF HEARING Date Time Location (Include Room Number) Presiding Judge If you require reasonable accommodations due to a disability to participate in the court process, please call prior to the scheduled court date. Please note that the court does not provide transportation. DISTRIBUTION: 1. Court 2. Child (if 12 years of age or older) n 5. District Attorney/Corporation Counsel 7. Placement 8. Petitioner 9. Agency 10. Tribe (if any) 11. Indian Custodian American LegalNet, Inc. www.FormsWorkFlow.com