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GN-3100, 11/12 Petition for Temporary Guardianship and/or Permanent Guardianship Due to Incompetency §§50.06, 54.10(3), 54.34, 54.44(1), 54.50, 54.852(7)
and Ch. 54, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
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STATE OF WISCONSIN, CIRCUIT COURT, COUNTY
For Official Use
IN THE MATTER OF
Amended
Petition for
Temporary
Permanent
Guardianship
Due to Incompetency
Date of Birth
Case No.
FOR ALL GUARDIANSHIPS (Complete #1 through #10)
UNDER OATH, I STATE:
1. I am interested as
a relative. I am related to the individual as .
a public official. My authority to act as petitioner is .
Other: .
2. This petition is filed in the county in which the individual
resides.
is physically present.
Other:
3. The individual lives in County, State of ,
and the individual’s mailing address is [Street, City, State, Zip] .
4. The name and mailing address of the person or institution, if any, that has care and custody of the individual or
the facility, if any, that is providing care to the individual is:
Name Phone Number
Mailing Address [Street, City, State, Zip]
This petition for guardianship is filed with a petition for protective placement prior to transfer of the individual
directly from a hospital to a nursing facility or community-based residential facility under §50.06, Wisconsin
Statutes.
5. The names and mailing addresses of all interested parties (including the petitioner) and all others entitled to notice
are as follows: See attached
Name
Relationship
Mailing Address
[Street, City, State, Zip]
Wisconsin Guardianship Form
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