Fill and Sign the Childs Guardian Ad Litem Form

JC-1605, 02/18 Petition For Appointment of Guardian/Notice of Hearing §§48.623(1), 48.831 and 48.977, W isconsin Statutes 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. Amended Petition for Appointment of Guardian/Notice of Hearing Date of Birth Case No. I STATE ON INFORMATION AND BELIEF: 1. The petitioner is the child. the child’s guardian ad litem. the child’s guardian. the child’s legal custodian. the child’s parent. the department. a county department. the person with whom the child is placed and who is nominated as the child’s guardian in this petition. the licensed child welfare agency assigned primary responsibili ty for providing services to the child under a court order or licensed to accept guardianship. a person representing the interests of the public under §48.09 , Wis. Stats. a person with whom the child has resided who has acted as a pare nt. 2. Child’s Address Child has previously been adopted? Yes No Parent 1 ’s Name and Address Parent 1 is deceased Parent 2 ’s Name and Address Parent 2 is deceased Guardian’s Name and Address Legal Custodian’s Name and Address 3. The child was adjudicated in need of protection or services un der § on [Date] and has been placed, or continued in a placement, outside of h is or her home pursuant to one or more court orders un der § . 4. The facts and circumstances which establish that the condi tions specified under §48.977(2)(b)-(f), Wis. Stats. met are: See attached 5. These proceedings are are not subject to the Uniform Child Custody Jurisdiction and En forcement Act. 6. The child is is not may be subject to the federal Indian C hild Welfare Act. Tribe/address: 7. The person with whom the child is placed and nominated as the guardian of the child is Address: 8. The person nominated as the successor guardian is Address : 9. The person representing the interests of the public under §48.09, Wi s. Stats., is 10. The agency primarily responsible for providing services to the child under a court order is Petition For Appointment of Guardian/Notice of Hearing Page 2 of 2 Case No. JC-1605, 02/18 Petition For Appointment of Guardian/Notice of Heari ng §§48.623(1), 48.831 and 48.977, W isconsin Statutes This form shall not be modified. It may be supplemented with additional mater ial. Page 2 of 2 11 . The department or county department has determined that the pro posed guardian is eligible to receive monthly subsidized guardianship payments under §48.623(1) , Wis. Stats., and it is requested that the court confirm those determinations. Attach department eligibility statement. I request that [Name] be appointed guardian of the child. Signature of Petitioner Name Printed or Typed Date This case is scheduled for a plea hearing as scheduled below : NOTICE OF HEARING Date Time Location (Include Room Number) Presiding Judge DISTRIBUTION: 1. Court 2. Child (if 12 years of age or older) 3. Ch ild’s Guardian/Legal Custodian 4. Child’s Guardian ad Litem (if any) 5. District Attorney/Corporation Counsel 6. Child’s parent 7. Placement 8. Petitioner 9. Agency 10. Tribe (if any) 11. Indian Custodian