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Guardians Report 17.7 - Ohio

Guardians Report Form. This is a Ohio form and can be used in Guardianship Probate Summit County (Court Of Common Pleas) .
 Fillable pdf Last Modified 1/16/2014
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PROBATE COURT OF SUMMIT COUNTY, OHIO GUARDIANSHIP OF: CASE NO. GUARDIAN'S REPORT (R.C. 2111.49) NOTE: If allotted space is inadequate to respond, write "See Exhibit" in the space and add appropriate exhibit letter sequence, then attach exhibit containing information requested for that space. 1. This is the (circle one): 1st, 2nd, 3rd, 4th, 5th, 6th, or 2. Ward's present address: City Zip State Telephone Include Area Code , Guardian's Report. 3. Ward's living arrangements at the above address are best described as: a. His or her own apartment or home (includes assisted living facilities). b. Private home or apartment of: (1) the ward's guardian (2) a relative of the ward, whose name is and relationship is (3) a non-relative, whose name is c. A foster, group, or boarding home. d. A nursing home. e. A medical facility or state institution. f. Other (describe): g. If c, d, e, or f is checked, complete the following: (1) The name of the home, facility or institution (2) The name of an individual at the home, facility or institution who has knowledge and is authorized to give information to the Court about the ward. Name Telephone Number . Include Area Code , . 4. The ward will be at the address given in item 2: a. Indefinitely. b. Temporarily. The new address and telephone number is: (1) Unknown. I will provide this information when known. (2) City Zip Telephone State Include Area Code Form 17.7 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. ________________________ 5. Guardian's contact with the ward: a. Approximate number of times the guardian had contact with the ward during the period covered by this report: b. The nature of those contacts (phone, personal, or other): c. Date the ward was last seen by the guardian: 6. Have you observed any major change in the ward's physical or mental condition during the period covered by this report? Yes No If "Yes" is checked, briefly describe the changes. 7. The care given to the ward is Adequate If "Not Adequate" is checked, explain. Not Adequate 8. The guardianship should be Continued If "Not Continued" is checked, explain. Not Continued 9. During the period covered by this report, the ward Has Has Not been seen by a physician. If the ward has been seen, the last date was and for the purpose of Attached is a statement by a licensed physician, a licensed clinical psychologist, a licensed social worker, or a mental retardation team, that has evaluated or examined the ward within three months prior to the date of this report regarding the need for continuing the guardianship. (R.C.2111.49 (A)(1)(i)) (Form 17.1) If an attorney has been consulted on this report: Attorney for Guardian Typed or Printed Name Address City Phone Number (Include Area Code) Supreme Court Registration Number State Zip Date Guardian Signature Typed or Printed Name Address City Phone Number (Include Area Code) State Zip (KNOWINGLY GIVING FALSE INFORMATION ON A PROBATE DOCUMENT IS A CRIMINAL OFFENSE) (R.C. 2921.13 (A)(11)) American LegalNet, Inc. www.FormsWorkFlow.com
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