STATE OF WISCONSIN, CIRCUIT COURT, COUNTY
IN THE INTEREST OF
a person under the age of 18
Date of Birth / Amended
Petition for Appointment of Guardian/Notice of Hearing
(Chapter 48)
Case No.

I state on information and belief:

1. / Child’s Address
Child has previously been adopted? Yes No
Parent 1’s Name and AddressParent 1 is deceased
Parent 2’s Name and AddressParent 2 is deceased
Guardian’s Name and Address
Legal Custodian’s Name and Address

2.These proceedingsareare not subject to the Uniform Child Custody Jurisdiction and Enforcement Act.

3.The childisis notmay besubject to the federal Indian Child Welfare Act.

Tribe/address:

4.The person or agency nominated as the guardian of the child is

Address:

5. The appointment of a guardian is being requested for a child in need of protection or services.

  1. The petitioner isthe child.the child’s guardian ad litem.the child’s guardian.the child’s parent.

the child’s legal custodian. the child’s Indian custodian.the department.a county department.

the person with whom the child is placed or in whose home placement of the child is recommended and who is nominated as the child’s guardian in this Petition.

the licensed child welfare agency assigned primary responsibility for providing services to the child under a court.

a person representing the interests of the public under §48.09, Wis. Stats.

b.The child was adjudicated in need of protection or services under §, Wis. Stats., on

[Date] and has been placed, or continued in a placement, outside of his or her home pursuant to one or more court orders under § , Wis. Stats.

c.The facts and circumstances which establish that the conditions specified under §48.977(2)(b)-(f), Wis. Stats. met are: See attached

d.The person nominated as the successor guardian is

Address:

e.The person representing the interests of the public under §48.09, Wis. Stats., is

f. The agency primarily responsible for providing services to the child under a court order is

g.The department or county departmenthas determined that the proposed 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.

6. The appointment of guardian is being requested for a child without a living parent.

a.The petitioner is a relative or family member of the child. the department. a county department.

a person with whom the child has resided who has acted as a parent.

a child welfare agency licensed under § 48.61(5), Wis. Stats., to accept guardianship.

a guardian appointed under ch. 54 whose resignation as guardian has been accepted by a court under §54.54, Wis. Stats.

b.Adoption is is not in the best interest of the child.

I request that[Name]be appointed guardian of the child.

Signature of Petitioner / Name Printed or Typed / Date

This case is scheduled for a hearing as scheduled below:

NOTICE OF HEARING
Date / Time / Location (Include Room Number)
Presiding Judge
If you require reasonableaccommodations due to adisability to participate in the court process, please call prior to the scheduled court date. Please note that the court does not provide transportation.
Distribution:
1. Court
2. Child (if 12 years of age or older)
3. Child’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

JC-1605, 05/18 Petition For Appointment of Guardian/Notice of Hearing§§48.623(1), 48.831 and 48.977, Wisconsin Statutes

This form shall not be modified. It may be supplemented with additional material.

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