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Annual Report Of Guardian AOC-790 - Kentucky

Annual Report Of Guardian Form. This is a Kentucky form and can be used in Hospitalization-Disability Statewide .
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AOC-790 Rev. 12-03 Page 1 of 3 Doc. Code: RGD Case No.______________________ Court_________________________ Commonwealth of Kentucky Court of Justice www.kycourts.net KRS 387.670 ANNUAL REPORT OF GUARDIAN County_______________________ COMMONWEALTH OF KENTUCKY VS. _____________________________________________ RESPONDENT ) ) ) ) ) ) ) ) ************ I, the undersigned, state that I am the [ ] Guardian [ ] Limited Guardian of the above-named Respondent, and report to the Court as follows: 1. 2. 3. 4. Present age of Ward:___________________________________. Date of birth:__________________________________________. Current address of Ward:________________________________________________________________________. Ward's present living arrangment is: [ ] Own home [ ] Guardian's home [ ] Hospital [ ] Relative's home ___________________ Relationship [] Other:____________________________________________________________________________________________ 5. Ward has been at present residence since____________________________________________________________. If Ward has lived elsewhere during the reporting period, list description and address of each residence and the length of stay at each. ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ [ ] Nursing home [ ] Skilled care [ ] Intermediate care [ ] Personal care American LegalNet, Inc. www.USCourtForms.com AOC-790 Rev. 12-03 Page 2 of 3 6. Doc. Code: RGD During this reporting period, the Ward's mental condition has: [ ] Remained about the same. [ ] Improved. Describe:________________________________________________________________________ ________________________________________________________________________________________ [ ] Deteriorated. Describe:______________________________________________________________________ ________________________________________________________________________________________ 7. During this reporting period, the Ward's physical health has: [ ] Remained about the same. [ ] Improved. Describe:________________________________________________________________________ ________________________________________________________________________________________ [ ] Deteriorated. Describe:______________________________________________________________________ ________________________________________________________________________________________ 8. During this reporting period, the Ward's social condition has: [ ] Remained about the same. [ ] Improved. Describe:________________________________________________________________________ ________________________________________________________________________________________ [ ] Deteriorated. Describe:______________________________________________________________________ ________________________________________________________________________________________ 9. During this reporting period, the Ward has received the following services: Medical: Educational: Social: Vocational: Other: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 10. My visits and activities on behalf of the Ward were: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ American LegalNet, Inc. www.USCourtForms.com AOC-790 Rev. 12-03 Page 3 of 3 Doc. Code: RGD 11. The guardian [ ] should [ ] should not be continued or modified for the following reasons: ____________________________________________________________________________________________ ____________________________________________________________________________________________ 12. I [ ] do [ ] do not have responsibility for managing the Ward's estate. If so, an accounting of the estate [ ] is attached [ ] was filed last year. A standby guardian [ ] has [ ] has not been appointed. 13. _________________________________________ Date _________________________________________ Guardian's Phone Number _________________________________________ Guardian's Social Security Number _____________________________________________ Guardian _____________________________________________ _____________________________________________ Address ************ SUBSCRIBED and SWORN to before me this______________day of____________________________, ________. My Commission expires:____________________________________________. _____________________________________________ Notary Public ************ To be signed by Standby Guardian if one is appointed. I, the undersigned, state that I am the Standby Guardian of the above-named Respondent and continue to be willing to serve in the event of the death, resignation, removal or incapacity of the Guardian. _________________________________________ Date _________________________________________ Standby Guardian's Phone Number _________________________________________ Standby Guardian's Social Security Number _____________________________________________ Signature of Standby Guardian _____________________________________________ _____________________________________________ Address American LegalNet, Inc. www.USCourtForms.com
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