Initial Report Of Guardian

SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK --------------------------------------IN THE MATTER OF THE APPLICATION OF , Petitioner, FOR THE APPOINTMENT OF A GUARDIAN FOR , An Alleged Incapacitated Person, --------------------------------------- IAS Part No. Index No. INITIAL REPORT OF GUARDIAN , the Guardian in this proceeding, submits this Initial Report of Guardian pursuant to Mental Hygiene Law § 81.30 and states as follows: 1. I reside at . My telephone number is . I was appointed guardian of the person [or property or person and property] of [THE INCAPACITATED PERSON] by Order and Judgment of the Honorable , Justice of the Supreme Court of the State of New York, dated . I received my commission on . 2. I am not related to the incapacitated person [or I am the incapacitated person's [NAME RELATIONSHIP]]. The incapacitated person's date of birth is . I shall separately provide to the court's Guardianship and Fiduciary Support Office (60 Centre Street, Room 148) the incapacitated person's social security number. 3. I attended the guardianship training course at on [DATE] [ or I did not attend the guardianship training course because ]. I have attached a copy of the certificate evidencing my completion of the course. 4. The incapacitated person is currently living at the following address: . I visited him [ her ] there on the following days: . American LegalNet, Inc. www.FormsWorkFlow.com 5. The incapacitated person's primary diagnosis is [Set forth the diagnosis of the IP's medical condition] . This statement is based upon [e.g., Doctor's report] . 6. If the incapacitated person lives in an apartment or a house, list here the name and relationship of all other persons living with the incapacitated person: . 7. If the incapacitated person has home care services, describe the services here and state the number of hours a day each such service is provided: . 2 American LegalNet, Inc. www.FormsWorkFlow.com 8. The incapacitated person has a [ check all that apply ]: G Will G Living Will G Health Care Proxy G Power of Attorney If you are uncertain as to whether any one of these documents exists, please explain: . As to each of the documents listed below, please indicate by marking "Yes," "No," or "NA" [for Not Applicable] whether you have located the document, provided a copy, or filed same with the Surrogate's Court: Determined Location Will Living Will Health Care Proxy Power of Attorney Other Guardians of the Person Answer the Following Questions: 9. I have taken the following steps to ensure that the Incapacitated person has adequate medical, dental, mental health or other health care services [ PLEASE DESCRIBE ] : Provided Copy Filed with Surr. Ct. 3 American LegalNet, Inc. www.FormsWorkFlow.com . 10. The plan to ensure that the incapacitated person has adequate medical, dental, mental health or other health care services in the future is as follows [ PLEASE DESCRIBE ]: . 11. I have taken the following steps to ensure that the incapacitated person has adequate social and personal services (for example, day care and recreation) [ PLEASE DESCRIBE ]: . 12. I have applied for the following health and accident insurance and government benefits on behalf of the incapacitated person [ PLEASE DESCRIBE ]: 4 American LegalNet, Inc. www.FormsWorkFlow.com . 13. There is no need to modify my powers as personal needs guardian [ or the following changes are necessary in my personal needs powers ] [ PLEASE DESCRIBE]]: . Guardians of the Property of the Incapacitated Person Fill In the Following Information 14. I have marshaled the following assets of the incapacitated person: A.(1) Bank Accounts [list the name of the bank, account numbers and amount of money in the account before you closed the account and transferred the money to a guardianship account] : Bank Account Number Amount 5 American LegalNet, Inc. www.FormsWorkFlow.com (2) Guardianship Bank Accounts [list the name of the bank, account numbers and the amount of money currently in the guardianship bank accounts]: Bank Account Number Amount B. Safe Deposit Box [ if the incapacitated person has a safe deposit box, list the name and address of the bank at which it is located] . Have you inventoried the contents of the safe deposit box? GYes GNo. If yes, attach a list of the contents and the appraisal or the approximate value of the contents. C. Stocks and Securities [ if the incapacitated person owns stocks or other securities, list here 6 American LegalNet, Inc. www.FormsWorkFlow.com the name of the company, number of shares, the market value of each security on the date you received your commission, and the broker ] : Company Name Number of Shares Market Value Brokerage Company Name Type of Bonds etc. Market Value Brokerage D. Real Estate [ list the address of the property, give a description of the property [i.e. store, single family house], approximate value of the property on the date you were commissioned, and name of tenants and rental income, if any. Also, write down the date you filed a statement 7 American LegalNet, Inc. www.FormsWorkFlow.com identifying real property with the County Clerk. ] : Address Description Approx. Value Tenants Rental Income Statement E. Personal Property [ list any jewelry, antiques, paintings, automobiles, or other valuable property or cash and set forth the approximate value ] : Property Type Appraised Value Approx. Value 8 American LegalNet, Inc. www.FormsWorkFlow.com F. Income [ set forth here all sources of income for the incapacitated person, i.e. social security, pensions, etc. and the monthly or annual amount received ] : Source of Income Amount G. Assets Not Yet Marshaled [ list all property owned by the incapacitated person that you have not yet been able to transfer to the guardianship ] : 9 American LegalNet, Inc. www.FormsWorkFlow.com . 15. There is no need to modify my powers as property guardian [ or the following changes are necessary to my powers as property guardian [EXPLAIN] : . 16. I G WILL [ or ] G WILL NOT need help preparing my annual report [ CHECK ONE ]. 10 American LegalNet, Inc. www.FormsWorkFlow.com ) ) ss.: COUNTY OF NEW YORK) , being duly sworn, states as follows: I am the guardian for the above-named incapacitated person, having been duly appointed by Order and Judgment of the Supreme Court of the State of New York, New York County. The foregoing Initial Report, including the account and inventory therein, contains, to the best of my knowledge and