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Guardian Ad Litem Report 07 - Washington
| Guardian Ad Litem Report Form. This is a Washington form and can be used in Guardianship Superior Court Spokane Local County . |
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(Copy Receipt) (Clerks Date Stamp) SUPERIOR COURT OF WASHINGTON COUNTY OF In the Guardianship of: CASE NO. GUARDIAN AD LITEM REPORT RCW 11.88.090 (RTGAL) RECOMMENDATION: 1.0 Procedural History. Date of Appointment: Date of Service of Copy of Petition on Guardian ad Litem: Date Guardian ad Litems Statement of Qualifications was filed & served: I attest that I am on the Guardian ad Litem Registry for this County, have conducted approximately Title XI Guardian ad Litem investigations, and am qualified to serve as Guardian ad Litem in Guardianship matters. 2.0 Medical/Psychological Report. As required by RCW 11.88.045, I have obtained a written, medical/psychiatric report from . The report was filed with the Court on . (Do not attach medical report to GAL report.) The examining physician/psychiatrist was selected by . The reason for selecting this individual to prepare the medical/psychiatric report was . GAL REPORT PAGE 1 OF 7 2000 GUARDIANSHIP FORMS <<<<<<<<<********>>>>>>>>>>>>> 23.0 Meeting(s) with Alleged Incapacitated Person. Dates of Meetings with Location of Meeting Other Persons Present Alleged Incapacitated (GAL must meet alone at least Person once with Alleged Incapacitated Person.) .1 Personal Information Regarding Alleged Incapacitated Person: Date of Birth: Age: Current Residence: Current Phone Number (with area code): Social Security Number: DSHS Client Number: .2 Incapacitated Persons Responses Regarding Specific Issues: Agreement or objection to appointment of a Guardian: Reaction to the proposed Guardian: Right to counsel: Preferences regarding choice of counsel: Right to a jury trial: .3 Summary of Interviews with Alleged Incapacitated Person and Guardian ad Litems Impressions. (Report as closely as possible the Alleged Incapacitated Persons own words when appropriate.) 2.0 Investigation. .1 Individuals Contacted. GAL REPORT PAGE 2 OF 7 2000 GUARDIANSHIP FORMS <<<<<<<<<********>>>>>>>>>>>>> 3(Name each person contacted and date(s) of contact. Explain the relationship of the interviewed person with the case or Alleged Incapacitated Person and what information that person contributed to your understanding the circumstances surrounding the Guardianship Petition). .2 Written Materials Reviewed . 3.0 Nature, Cause and Degree of Incapacity Functional Limitations. .1 Medical Diagnosis and Cause. .2 Degree of Incapacity. 4.0 Alternatives to Guardianship. 5.0 Abilities of Alleged Incapacitated Person and Degree of Assistance Required. 6.0 Recommendation as to Appointment of Guardian. 7.0 Recommendation Regarding Alleged Incapacitated Persons Right to Vote: 8.0 Evaluation of Proposed Guardian: .1 Dates of Contact Between Guardian ad Litem and Proposed Guardian and Written Materials Reviewed: .2 Identity and Contact Information Regarding Proposed Guardian: Name: Mailing Address: Street Address (if different from above): Telephone Number: Fax Number: GAL REPORT PAGE 3 OF 7 2000 GUARDIANSHIP FORMS <<<<<<<<<********>>>>>>>>>>>>> 4Email Address: If Guardian is Certified, Provide Certification No.: Relationship, if any, between Proposed Guardian and Alleged Incapacitated Person: .3 Description of Steps Proposed Guardian Has or Intends to Take to Meet the Alleged Incapacitated Persons Needs. 9.0 Recommendation Regarding Advice of Right to Jury Trial. 10.0 Recommendation Regarding Appointment of Independent Counsel. 11.0 Estimate of Estate (Based on Available Information). Real Property $ Cash on Hand $ Business $ Securities $ Mortgages and Notes $ Bank/Trust Account $ Cash Surrender Value Insurance $ Personal Property $ Sources of Income $ Other: $ $ $ $ ESTIMATED TOTAL $ 1.0 Recommendation Regarding Bond/Annual Reports. I recommend that: insert text-amount] . insert text-amount] The Guardian file financial reports every year every other year GAL REPORT PAGE 4 OF 7 2000 GUARDIANSHIP FORMS <<<<<<<<<********>>>>>>>>>>>>> 5 every third year GAL REPORT PAGE 5 OF 7 2000 GUARDIANSHIP FORMS <<<<<<<<<********>>>>>>>>>>>>> 6 Recommendation Regarding Presence of Alleged Incapacitated Person at Hearing The presence of the Alleged Incapacitated Person should should not be waived. is able unable to attend the hearing. If unable to attend, please explain the reason(s): . The following special arrangements should be made for the hearing (i.e., removal of hearing site to residence of Alleged Incapacitated Person, provision for hearing assistive devices, etc.). Other Recommendations. 2.0 Recommendation as to Guardian ad Litems Continuing Involvement in Future Proceedings. I recommend that the Guardian ad Litem be not be involved in future proceedings in this matter. 3.0 Individuals Who Should be Advised of Their Right to Request Special Notice of Proceedings Pursuant to RCW 11.92.150. Name, Title and Address Relationship to Alleged Incapacitated Person I certify (or declare) under penalty of perjury under the laws of the State of Washington that to the best of my knowledge the statements above are true and correct. Signature of Guardian/Attorney Printed Name of Guardian/Attorney, GAL REPORT PAGE 6 OF 7 2000 GUARDIANSHIP FORMS <<<<<<<<<********>>>>>>>>>>>>> 7 WSBA/CPG# Address Telephone/Fax Number City, State, Zip Code Email Address GAL REPORT PAGE 7 OF 7 2000 GUARDIANSHIP FORMS
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