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STATE OF WISCONSIN CIRCUIT COURT DOUGLAS COUNTY In the Matter of the Guardianship of: REQUEST TO APPROVE (name) EXPENDITURE Case No.: I am the guardian of I am requesting Court approval to spend (for any single item expenditure in excess of $250.00), excluding medical or room and board/housing/rent expenses) of the ward’s funds for the benefit of the ward as follows OR you may attach estimates and supporting documentation for the requested expenditure. As guardian, I believe this expense is necessary and appropriate because: The current balance of the wards cash assets are: (Signature of Guardian) (Name printed/typed) (Date) ORDER The court having reviewed the request to which this Order is affixed hereby ORDERS the request is: _______APPROVED ____DENIED SET FOR HEARING HEARING DATE: Dated: Circuit Court Judge