Free CG 912M - West Virginia

IN THE CIRCUIT COURT OF _______________ COUNTY, WEST VIRGINIA
For Clerk's Use Only IN RE: ___________________________________________________________, DATE FILED: ____________________________________ A PROTECTED PERSON

CASE NUMBER ___________ - G - __________

PETITION FOR TERMINATION, REVOCATION OR MODIFICATION OF APPOINTMENT OF CONSERVATOR/GUARDIAN
[West Virginia Code: § 44A-4-6]

NOW COMES the Petitioner [name of person filing Petition]

_______________________________________

in the above captioned cause, and respectfully petitions this Court to [check the statement below which reflects what you want the Court to do]: __________ __________ __________ terminate the appointment of the conservator and/or guardian. revoke the appointment of the conservator and/or guardian. modify the type of appointment of the guardian and/or conservator, or modify the areas of protection, management or assistance previously granted. of [insert name of the Protected Person] __________________________________________. The grounds, facts, circumstances and reasons in support of this petition are as follows: __________________________________________

__________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ ________________________________________________________________. [Attach additional pages, if necessary.] Respectfully presented this _______ day of _________________________________, 20_______.

____________________________________________________ PETITIONER'S SIGNATURE
SCA-CG 912M / 6-94