Fill and Sign the Determination and Order on Petition for Guardianship Due to Incompetency Wisconsin Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE MATTER OF             Amended Determination and Order on Petition for Guardianship Due to Incompetency       Date of Birth Case No.       This matter is before the court on a Petition for Guardianship Due to Incompetency and a hearing has been held. Based upon consideration of the following: 1. the report of the guardian ad litem. 2. the medical or psychological reports, provided, ordered or offered to the court. 3. whether other reliable resources are available to provide for the individual's personal needs or property management, and whether appointment of a guardian is the least restrictive means to provide for the individual's need for a substitute decision maker. 4. the preferences, desires, and values of the individual with regard to personal needs or property management. 5. the nature and extent of the individual's care and treatment needs and property and financial affairs. 6. whether the individual's situation places him or her at risk of abuse, exploitation, neglect, or violation of rights. 7. whether the individual can adequately understand and appreciate the nature and consequences of his or her impairment. 8. the individual's management of the activities of daily living. 9. the individual's understanding and appreciation of the nature and consequences of any inability he or she may have with regard to personal needs or property management. 10. the extent of the demands placed on the individual by his or her personal needs and by the nature and extent of his or her property and financial affairs. 11. any physical illness of the individual and the prognosis of the individual. 12. any mental disability, alcoholism, or other drug dependence of the individual and the prognosis of the mental disability, alcoholism, or other drug dependence. 13. any medication with which the individual is being treated and the medication's effect on the individual's behavior, cognition, and judgment. 14. whether the effect on the individual's evaluative capacity is likely to be temporary or long term, and whether the effect may be ameliorated by appropriate treatment. 15. other relevant evidence. THE COURT FINDS: 1. JURISDICTION, VENUE, NOTICE AND EVALUATIONS TO COURT. A. This court does does not have jurisdiction of the subject matter and of the person of the individual. B. This court is is not a proper venue. C. Notice was was not properly served. D. The individual is: present. not present because the guardian ad litem waived the individual’s attendance. Other:       E. The proposed guardian and any proposed stand-by guardian are: present as follows:       not present and the court permits attendance by telephone for good cause shown as follows:       not present and the court excuses the attendance as follows:       F. Additional evaluations are not necessary. GN-3170, 10/06 Determination and Order on Petition for Guardianship Due to Incompetency §54.10(3), Chapter 46 and 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 6 Determination and Order on Petition for Guardianship Due to Incompetency Page 2 of 6 Case No. 2. CAPACITY AND NEED FOR GUARDIANSHIP. Upon presentation of clear and convincing evidence: the individual is not incompetent. advanced planning by the individual renders guardianship unnecessary. the elements of the petition are unproven. the application for appointment of a conservator by the proposed ward under §54.76 is appropriate. the individual has been adjudicated incompetent in another jurisdiction and a petition for receipt and acceptance of a foreign guardianship has been granted. the individual is a minor who has attained age 14 and is developmentally disabled. the individual is found to be incompetent as a result of: developmental disabilities serious and persistent mental illness degenerative brain disorder other like incapacities based upon the following standards: A. The individual is at least 17 years and 9 months. B. The individual’s need for assistance in decision making or communication is unable to be met effectively and less restrictively through appropriate and reasonably available training, education, support services, health care, assistive devices, or other means that the individual will accept. C. For purposes of appointment of guardian of the person , because of impairment, the individual is unable effectively to receive and evaluate information or to make or communicate decisions to such extent that the individual is unable to meet the essential requirements for the individual’s physical health and safety. D. For purposes of appointment of guardian of the estate, because of an impairment, the individual is unable effectively to receive and evaluate information or to make or communicate decisions related to management of the individual’s property or financial affairs, to the extent that at least one of the following applies: 1. The individual has property that will be dissipated in whole or in part or 2. The individual is unable to provide for the individual’s support or 3. The individual is unable to prevent financial exploitation. 3. RIGHTS AND POWERS. That the individual has incapacity in part or in full to exercise rights that are believed to be relevant to the individual’s present or future decision making. A. Rights removed from the individual. The individual has incapacity to exercise one or more of the following rights: consent to marriage. execute a will. serve on a jury. apply for an operator’s license, a hunting, fishing or other license issued under ch. 29, or a credential as defined in §440.01(2), Wisconsin Statutes:       consent to sterilization. consent to organ, tissue, or bone marrow donation. register to vote or vote in an election. B. Rights the individual may exercise with the consent of the guardian of the person. The individual is competent to exercise the following rights under some but not all circumstances. The individual retains the right only with consent of the guardian of person to: consent to marriage. apply for an operator’s license, a hunting, fishing or other license issued under ch. 29, or a credential as defined in §440.01(2), Wisconsin Statutes:       consent to sterilization. consent to organ, tissue, or bone marrow donation. GN-3170, 10/06 Determination and Order on Petition for Guardianship Due to Incompetency §54.10(3), Chapter 46 and 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 6 Determination and Order on Petition for Guardianship Due to Incompetency Page 3 of 6 Case No. C. Transfer of powers to guardian of person. The individual lacks evaluative capacity to exercise the following powers, in full or part. It is appropriate to appoint a guardian of the person with authority to exercise all or part of specific powers as follows: consent to medical examination and treatment, and consent to voluntary medication, including psychotropic medication that is in the individual’s best interests, if the guardian has first made a good-faith attempt to discuss with the individual the individual’s voluntary receipt of the psychotropic medication and the individual does not protest. Guardian of person’s authority: full limited       authorize individual’s participation in an accredited or certified research project if the research project might help the individual, or others if minimal risk of harm. Guardian of person’s authority: full limited       authorize individual’s participation in research that might not help the individual but might help others if greater than minimal risk of harm to the individual but evidence indicates individual would have elected to participate. Guardian of person’s authority: full limited       consent to experimental treatment in the individual’s best interests. Guardian of person’s authority: full limited       consent to receipt by individual of social and supported living services. Guardian of person’s authority: full limited       consent to release of confidential records other than court, treatment, and patient health care records and redisclosure as appropriate. Guardian of person’s authority: full limited       power to make decisions related to mobility and travel. Guardian of person’s authority: full limited       power to choose providers of medical, social, and supported living services. Guardian of person’s authority: full limited       power to make decisions regarding educational and vocational placement and support services or employment. Guardian of person’s authority: full limited       power to make decisions regarding initiating a petition for termination of marriage. Guardian of person’s authority: full limited       power to receive all notices on behalf of individual . Guardian of person’s authority: full limited       power to act in all proceedings as an advocate of the individual, except the power to enter into a contract that binds the individual or the individual’s property or to represent the individual in any legal proceedings pertaining to the property, unless the guardian of the person is also the guardian of the estate. Guardian of person’s authority: full limited       power to apply for protective placement or for commitment. Guardian of person’s authority: full limited       GN-3170, 10/06 Determination and Order on Petition for Guardianship Due to Incompetency §54.10(3), Chapter 46 and 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 6 Determination and Order on Petition for Guardianship Due to Incompetency Page 4 of 6 Case No. power to have custody of the individual, if an adult, and the power to have care, custody, and control of the individual, if a minor. Guardian of person’s authority: full limited       other specific power(s):       See attached. D. Transfer of powers to guardian of the estate. It is appropriate to: Appoint a guardian of the estate with: 1. duties under §54.19; 2. standard powers under §54.20(1), and 3. powers that do not require court approval under §54.20(3) Guardian of estate’s authority: full limited       Authorize the guardian of the estate to exercise additional powers requiring court approval under §54.20(2), other than to make gifts, as follows:       Dispense with bond and order deposit of individual’s funds of $100,000 or less in an insured account of a bank, credit union, savings bank or savings and loan association in the name of the guardian and the ward, and payable only upon further order of the court. Dispense with an appointment of a guardian of the estate and transfer the individual’s funds of $50,000 or less under one of the alternatives for small estates under §54.12(1), WI Statutes, as follows:       4. POWERS OF ATTORNEY. Even though the ward has executed a financial durable power of attorney, has a current, valid power of attorney for health care, or other advanced planning, guardianship is still necessary, for the following reasons:       Good cause exists to revoke or limit the power of attorney for health care because:       Good cause exists to revoke or limit the durable financial power of attorney because:       The appointment of the agent under the individual’s power of attorney for health care as guardian of the person is not in the best interest of the individual because:       The appointment of the agent under the individual’s durable financial power of attorney as guardian of the estate is not in the best interest of the individual because:       5. SUITABILITY OF GUARDIAN. Based upon the Statement of Acts by Proposed Guardian and Consent to Serve, the recommendation of guardian ad litem, and the court having considered all nominations and applicable preferences and criteria, including the opinions of the proposed ward and of the members of his or her family, and any potential conflicts of interest resulting from the proposed guardian's employment or other potential conflicts of interest, the following person or organization is competent and suitable to be appointed: Type of Guardian Name & Address Phone Guardian of the Person             Guardian of the Estate             Standby Guardian of the Person             Standby Guardian of the Estate             6. PETITIONER’S ATTORNEY FEES AND COSTS. It is equitable inequitable GN-3170, 10/06 Determination and Order on Petition for Guardianship Due to Incompetency §54.10(3), Chapter 46 and 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 4 of 6 Determination and Order on Petition for Guardianship Due to Incompetency Page 5 of 6 Case No. to award payment of petitioner’s reasonable attorney fees and costs from the individual’s income and assets. THE COURT ORDERS: The petition is: dismissed. granted as follows: 1. POWERS OF ATTORNEY. The power of attorney for health care: remains in effect. is revoked. is limited as follows:       . The durable financial power of attorney: remains in effect. is revoked. is limited as follows:       . 2. APPOINTMENT OF GUARDIAN . The court appoints t he following: Type of Guardian Name & Address Phone Guardian of the Person             Guardian of the Estate             Standby Guardian of the Person             Standby Guardian of the Estate             3 . LIMITATIONS AND POWERS. A. The guardian is authorized to exercise powers in part or in full consistent with the above findings in a manner that is appropriate to the individual and that constitutes the least restrictive form of intervention. B. Co-Guardians must concur with each other when making decisions on behalf of the ward unless otherwise ordered by the court as follows:       . 4. BOND. The guardian of the estate : shall be issued letters of guardianship upon filing surety bond signature bond in the amount of $       . is not required to file a bond provided that the guardian shall deposit the individual’s funds of $100,000 or less in an insured account in the name of the guardian and the individual, and payable only upon further order of the court. Proof of deposit shall be filed with the court within       days. is not required to file a bond and bond is waived. Other:       5. INVENTORY, ANNUAL ACCOUNT, ANNUAL REPORT. Inventory and Annual Account. The guardian of the estate shall file an inventory of the individual’s assets within 60 days . The guardian of the estate shall file an account by April 15 of each year or as otherwise required by the court as follows:       The guardian of the estate is authorized to file a Modified Annual Account of Married Ward which shall be filed by April 15 of each year or as otherwise required by the court as follows:       . Annual Report. The guardian of person shall file Annual Report on the Condition of the Ward. GN-3170, 10/06 Determination and Order on Petition for Guardianship Due to Incompetency §54.10(3), Chapter 46 and 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 5 of 6 Determination and Order on Petition for Guardianship Due to Incompetency Page 6 of 6 Case No. 6. CHANGE OF ADDRESS. The guardian shall immediately notify the court in writing of any change in the address of the individual or of the guardian. 7. ALTERNATIVE TO GUARDIANSHIP OF ESTATE. As an alternative to appointing a guardian of the estate, the individual’s funds of $50,000 or less shall be transferred under one of the alternatives for small estates under §54.12(1), as follows:       8. FEES AND COSTS OF PROCEEDING. A. Guardian is not appointed. The petitioner shall pay the compensation of the guardian ad litem and the individual’s legal counsel. B . Guardian is appointed. 1. Reasonable compensation of the guardian ad litem and individual’s counsel shall be paid from the individual’s income or assets, if sufficient. If the individual’s income or assets are insufficient, the guardian ad litem shall be paid by the county of venue and the individual’s counsel shall be paid at public expense or by the county of venue. 2. Petitioner’s reasonable attorney fees and costs shall be paid: by the petitioner. from the individual’s income or assets. C. Other:       9. GUARDIAN’S COMPENSATION AND REIMBURSEMENT. The guardian’s compensation and reimbursement of expenses, if any, must be approved by the court before payment is made . Name of Attorney       BY THE COURT: Circuit Court Judge/Court Commissioner       Name Printed or Typed       DateAddress       Telephone Number       Bar Number       GN-3170, 10/06 Determination and Order on Petition for Guardianship Due to Incompetency §54.10(3), Chapter 46 and 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 6 of 6