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STATE OF WISCONSIN CIRCUIT COURT DOUGLAS COUNTY In the Matter of the Guardianship of: PETITION AND ORDER FOR (Name of Ward) GUARDIAN FEES Case No.: I, as guardian of the above-named ward hereby petition the Court for fees and expenses for services provided to the ward for the period from to in the amount of I certify that the following information is true and correct: 1. The balance of the ward’s assets on the date this petition was signed is: 2. Of the total amount listed in No. 1 above, the amount of cash on hand is: During the above named period of time I provided the following services: I met with the ward on occasions and spent approximately hours handling guardianship matters for the ward. I wrote checks and made deposits on behalf of the ward. In addition to the above I provided the following services for and on behalf of the ward for which I believe I am entitled to be compensated: (attach a separate sheet if necessary) I incurred miles on my personal vehicle on behalf of the ward which included trips for the following purpose: (attach a separate sheet if necessary) I incurred the following additional expenses while conducting business on behalf of the ward: (attach a separate sheet if necessary) ---PAGE BREAK--- I attended court hearings on behalf of the ward and spent hours conferring with legal counsel concerning the ward’s affairs. Other factors I believe the Court should consider in setting a reasonable fee for services rendered is: The total amount of compensation I am requesting for the above time period ORDER Upon the petition of as guardian of IT IS HEREBY ORDERED that the sum of is allowed as guardian’s fees and the sum of is allowed as expenses and that the guardian be authorized to pay such fees and expenses from the ward’s assets within 30 days. Dated this day of BY THE COURT: Circuit Court Judge