Fill and Sign the Transfer Guardianship to Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE MATTER OF       Amended Certification on Request to Transfer Guardianship to Wisconsin       Date of Birth Case No.       To Circuit Court of:       County, Wisconsin: This Certification is made by       Court, State of       regarding Guardianship for this individual under the jurisdiction of this court as case number       . 1 . Notice has been received by this court that a petition has been filed in Circuit Court in       County, State of Wisconsin, requesting transfer of this guardianship from the State of       to the State of Wisconsin. 2 . T his court has been requested to provide this Certification and copies of all documents filed that are relevant to this guardianship. 3 . Except as noted below, this court has no knowledge that the guardian has engaged in any acts specified in § 54.68(2)(a) to (i), Wisconsin Statutes, as follows: a. failing to file timely an inventory or account, as required, that is accurate and complete. b. committing fraud, waste or mismanagement. c. abusing or neglecting the ward or knowingly permitting others to do so. d. engaging in self-dealing. e. failing to provide adequately for the personal needs of the ward from the ward’s available assets and income, including any available public funds. f. failing to exercise due diligence and reasonable care in assuring that the ward’s personal needs are being met in the least restrictive environment consistent with the ward’s needs and incapacities. g. failing to act in the best interests of the ward. h. failing to disclose conviction for a rime that would have prevented appointment of the person as guardian. i. failing to disclose that the guardian is listed in the caregiver misconduct registry under §146.40(4g)(a)2., Wisconsin Statutes. 4 . Except as noted below, this court has no knowledge that the guardian has failed to perform any duties of a guardian required by this jurisdiction or this court. 5 . Except as noted below, this court has no knowledge that the guardian has performed any acts prohibited to a guardian by this jurisdiction or this court. 6 . Exceptions:       See attached Signature of Court Official Name of Attorney             Court Official’s Title       Name Printed or TypedAddress       Telephone Number       Bar Number             Date GN-3830, 04/07 Certification on Request to Transfer Guardianship to Wisconsin §54.38(1m)(a) 2., Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.