Fill and Sign the 767407 Wisconsin Legislature Form

JC-1606, 02/17 Dispositional Order Appointing Guardian §§48.623(1), 48.831 and 48.977, W isconsin Statutes; 25 U.S.C. §1915. This form shall not be modified. It may be supplemented with additional mater ial. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY For Official Use IN THE INTEREST OF a person under the age of 18. Dispositional Order Appointing Guardian Date of Birth Case No. THE COURT FINDS: 1. a. The child has no living parent and adoption is is not in the best interests of the child. OR b. The child has living parent(s): [Names] 2. The child has been adjudged to be in need of protection or services under § , Wis. Stats., and has been placed, or continued in placement, outside his or her home pursuant to one or more court orders under § , Wis. Stats. 3. The person nominated as the guardian of the child is a person with whom the child has been pl aced and it is likely that the child will continue to be placed with that person for an extended period of time or until the child attains the age of 18. Name Address Phone 4. It is likely that the person, if appointed, would be willing and able to serve as the child’ s guardian for an extended period of time or until the child attains the age of 18. 5. It is not in the best interests of the child that a petition to terminate parental rights be filed with r espect to the child. 6. The parent(s) is/are refusing, neglecting or unable to carry out the duties of a guardian. 7. The agency primarily responsible for providing services: has made reasonable efforts t o return the child to his/her home , but reunification and further reunification efforts with the child’s parent(s) are unlikely or contrary to the best interests of the child. has made reasonable efforts to prevent the child’s removal , but continued placement of the child in the home would be contrary to the child’s welfare. is not required to make reasonable efforts to prevent the child’s removal or to return the child to his/her home under §48.355(2d)(b)1. to 5., Wis. Stats. 8. The court has jurisdiction under Ch. 822, Wis. Stats. 9. It is is not in the child’s best interests that the person be appointed guardian with: full powers enumerated under §48.023, Wis. Stats. powers limited to: 10 . T he determinations made under §48.623(1) , W is. Stats., that the guardian is eligible to receive monthly subsidized guardianship payments are confirmed. 11. An inquiry has been made on the record to each participant in this proceeding as to whether t he participant knows or has reason to know that the child is an Indian child. a. The child is not subject to the federal Indian Child W elfare Act. b. The child is subject to the federal Indian Child W elfare Act, AND placement has been made in accordance with the order of preference set forth in the Indian Child Welfare Act. OR Dispositional Order Appointing Guardian Page 2 of 2 Case No. JC-1606, 02/17 Dispositional Order Appointing Guardian §§48.623(1), 48.831 and 48.977, W isconsin Statutes; 25 U.S.C. §1915. This form shall not be modified. It may be supplemented with additional mater ial. Page 2 of 2 there is good cause to depart from the order of placement preference in the Indian Child Welfare Act: THE COURT ORDERS: The petition is 1. GRANTED and [Name] is appointed guardian with full powers enumerated under §48.023, Wis. Stats. powers limited to: 2. DENIED and this matter is dismissed. THIS IS A FINAL ORDER FOR PURPOSES OF APPEAL. BY THE COURT: DISTRIBUTION: 1. Court - Original 2. Parties 3. Tribe (if any) Circuit Court Judge Name Printed or Typed Date