Fill and Sign the This Matter is Before the Court on a Petition for Appointment of Conservator and a Hearing Has Been Held Form

GN -3380, 05/17 Order on Petition for Appointment of Conservator §54.76, W isconsin 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 MATTER OF Amended Order on Petition for Appointment of Conservator Date of Birth Case No. This matter is before the court on a Petition for Appointment of Conservator and a hearing has been held. The court has personally examined the petitioner and considered any other evidence presented. THE COURT FINDS : 1. JURISDICTION, VENUE AND NOTICE A. This court does does not have jurisdiction of the subject matter and of the person of the indi vidual. B. This court is is not a proper venue. C. Notice was was not properly served . 2. THE COURT is is not satisfied that A. the petitioner who is an adult resident of this county is unwilling or believes that he or she is unable to properly manage his or her assets or income and has voluntarily applied to the court for the appointment of a conservator of the estate; and B. the fiduciary and any standby conservator are suitable; and C. other statutory requirements for appointment of a conservator have been met. 3. CONSERVATOR OF THE ESTATE It is appropriate to A. appoint and authorize a permanent conservator of the estate to perform the duties of a guardian of the estate under §54.19 , W is. Stats. , and exercise the powers that do not require court approval under §54.20(3) , Wis. Stats . B. authorize the conservator of the estate to exercise additional powers requiring court approval under §54.20(2), Wis. Stats., [other than to make gifts ] as follows: . C. direct the conservator of the estate to deposit the 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 conservator and the individual , payable only u pon further order of the court . 4. The petitioner has executed a durable financial power of at torney. Good cause exists to revoke or limit the durable financial power of attorney because: . 5. SUITABILITY OF CONSERVATOR The following person or organization is competent and suitable to be appointed: Type of Conservator Name & Address Phone Conservator of the Estate Standby Conservator of the Estate THE COURT ORDERS: The petition is dismissed. granted as follows: Order on Petition for Appointment of Conservator Page 2 of 2 Case No. GN -3380 , 05/17 Order on Petition for Appointment of Conservator §54.76, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 1. POWERS OF ATTORNEY The dura ble financial power of attorney remains in effect. is revoked. is limited as follows: . 2. APPOINTMENT OF CONSERVATOR The court appoints the following : Type of Conservator Name & Address Phone Conservator of the Estate Standby Conservator of the Estate 3. LIMITATIONS AND POWERS The conservator 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. 4. BOND The conservator of the estate shall be issued letters of conservatorship upon filing surety bond signature bond in the amount of $ . is not required to file a bond provided that the conservator shall deposit the individual’s funds of $100,000 or less in an insured account in the name of the conservator 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. CONSENT TO SERVE Letters of Conservatorship shall be issued upon filing Consent to Serve and any required bond. 6. INVENTORY AND ANNUAL ACCOUNT The conservator of the estate shall file an inventory of the individual’s assets within 60 days . The conservator of the estate shall file an account by April 15 of each year or as otherwise required by the court as follows: . 7. CHANGE OF ADDRESS The conservator shall immediately notify the court in writing of any change in the address of the individual or of the conservator. 8. CONSERVATOR’S COMPENSATION AND REIMBURSEMENT The conservator’s compensation and reimbursement of expenses, if any, must be approved by the court before payment is made . THIS IS A FINAL ORDER FOR PURPOSES OF APPEAL IF SIGNED BY A CIRCUIT COURT JUDGE . BY THE COURT: Name of Attorney Circuit Court Judge/ Circuit Court Commissioner Print or Type Name if not eSigned Date Address Telephone Number Bar Number DISTRIBUTION: 1. Court 2. Standby Conservator