Note that many courts have a preferred template for the annual report, which may often be available online. Practitioners should check with the local court and consider whether there is a preferred form that should be used in a given case.
[Caption. See § 3 of the Introduction in this manual.]
Annual Report on Location, Condition, and Well-Being of Ward
I, [name of guardian], Guardian, represent that I am the guardian of the person of [name of ward], Ward, an incapacitated person, and that my annual report to the Court for the period from [date] through [date] is as follows:
1.Name of ward:
Telephone no.:
Date of birth:
Age:
|
If the ward has died, state the date and place of death and do not complete the rest of the form. |
2.Ward’s residence is [address, city, state]. This residence is [Guardian’s home/Ward’s home/a foster or boarding home/the home of Ward’s [describe relationship, e.g., mother]/a hospital or medical facility/a nursing home/[specify other]].
3.Ward has been in [his/her] present residence since [date]. [If the ward has moved within the past year, state the reasons for the change.]
4.As guardian, I rate Ward’s living arrangements as [excellent/average/below average]. [If below average, explain.]
5.As guardian, I believe Ward is [content/unhappy] with [his/her] living situation.
6.During the last twelve months I have seen Ward [number] times. The last date I saw Ward was [date].
7.As guardian, I [do/do not] have possession or control of Ward’s estate.
8.During the past year Ward’s mental health [improved/remained unchanged/became worse]. [If the ward’s mental health has changed, describe the change.]
9.During the past year Ward’s physical health [improved/remained unchanged/became worse]. [If the ward’s physical health has changed, describe the change.]
10.Ward [is/is not] under the regular care of a physician. [His/Her] doctor’s name is [name of doctor], and the doctor’s address is [address, city, state].
11.During the past year Ward has been treated or evaluated by [state the names and addresses of any service providers, such as physicians, dentists, social worker, etc., the date service was rendered, and the type of service received].
|
Select one of the following. |
12.During the past year Ward has participated in the following activities: [describe any recreational, educational, or occupational activities].
|
Or |
12.[There were no activities available to Ward/Ward refuses to participate in any activities/Ward is unable to participate in any activities].
|
Include the following if applicable. |
13.I believe Ward has the following unmet needs: [describe needs.]
|
Continue with the following. |
14.I have received $[amount] for Ward’s benefit from [name]. The amount of $[amount] was spent directly for Ward’s benefit in the following manner: [describe expenditure. Attach a statement if necessary.]
15.My powers as guardian should [be increased/be decreased/remain the same]. [Explain.]
16.I [have/have not] paid the bond premium for the next reporting period.
|
Include any other information concerning the ward’s condition that the court should be advised about. |
17.The guardianship [should/should not] be continued. [Explain.]
SIGNED on ________________________________.
[Name]
Guardian
[Address]
[Telephone]
[Name]
Attorney for Guardian
State Bar No.:
[Email address]
[Address]
[Telephone]
[Telecopier]
[Name of guardian] appeared in person before me today and stated under oath:
|
Select one of the following. |
|
The following should be used when the guardian is making a sworn declaration. |
“My name is [name of guardian]. I am competent to make this affidavit. The facts stated within the foregoing annual report are a true, correct, and complete statement of the present location, condition, and well-being of [name of ward], an incapacitated person, as of the date stated herein.”
Affiant
SIGNED under oath before me on ______________________________.
Notary Public, State of Texas
|
The following should be used if the guardian is making an unsworn declaration. |
“My name is [name of guardian], and my date of birth is [insert date of birth]. I am competent to make this affidavit. I declare under penalty of perjury that the facts stated within the foregoing annual report are a true, correct, and complete statement of the present location, condition, and well-being of [name of ward], an incapacitated person, as of the date stated herein.”
SIGNED on ________________________________.
[Name of guardian]
|
Include attachment(s). |