JDF 834 SC R 9/18 - MINOR Page 1 of 7 District Court Denver Probate Court County, Colorado Court Address: I n the Interest of : Minor COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom MINOR C urrent Reporting Period F rom T o (MM/DD/YYYY) (MM/DD/YYYY) (REPORTING DATES MUST BE FOR THE PAST YEAR AND MAY NOT REPORT INTO THE FUTURE.) Instructions to g uardian: You have been ordered to c on behalf of the minor . When answering the questions in this repor or may be rejected with those answers. COLORADO LAW REQUIRES THAT ANY GUARDIAN WANTING TO REMOVE THE MINOR CHILD FROM THE STATE OF COLORADO MUST OBTAIN COURT PERMISSION. You must file the necessary forms to make this request and obtain c ourt permission. CONTACT INFORMATION Minor Check if Updated Information from last R eport Name: Age : Street Address: (Include Name of Living Center or Nursing Home) City: State: Z ip Code: Mailing A ddress, if different: City: State: Zip Code: Primary P hone : Alternate P hone: Guardian n: Check if Updated Information from last Report Name: Age : Occupation: Your Relationship to Minor : Street Address: City: State: Zip Code: Mailing A ddress, if different: City: State: Zip Code: E - Mail Address: Primary Phone : Alternate Phone: American LegalNet, Inc. www.FormsWorkFlow.com JDF 834 SC R 9/18 - MINOR Page 2 of 7 Have you had any criminal charg es filed against you or convictions entered since the last report? Yes No If Yes, explain: Co - Guardian (if applicable) Check if Updated Information from last Report Name: Age : Occupation: Your Relationship to Minor: Street Address : Ci ty: State: Zip Code: Mailing A ddress, if different: City: State: Zip Code: E - Mail Address: Primary Phone : Alternate Phone: Have you had any criminal charges filed against you or convictions entered since the last report? Yes No If Yes, explain: I. STATUS INFORMATION Yes No A. Do you recommend that the guardianship continue? If No , explain: B. Do you recommend any changes to the guardianship? If Yes , explain: C. Do you wish to remain guardian? If No , explain: Note: If you wish to terminate this guardianship, or modify by replacing the current g uardian or adding a c o - g uardian, yo u must file a separate p etition with the c ourt. D. The m Very Good Good Adequate Poor E. Do you believe the current plan for care is in the m Yes No If No, describe your recommended changes: American LegalNet, Inc. www.FormsWorkFlow.com JDF 834 SC R 9/18 - MINOR Page 3 of 7 F. treatment on a daily basis? Name Primary P hone: Alternate P hone: G. Has the m report? Yes No If Yes , identify the date of the move, address of residence, type of residence and reason for the change. II. PERSONAL CARE AND OT HER ISSUES A. Date of the m Dental exam: B. Yes No If No , explain: C. Is the m inor covered under health or dental insurance? Yes No If Yes , describe coverage. If No , exp lain efforts to obtain coverage. D. Describe any counseling services provided to the m inor. E. Describe any other services provided to the m inor. F. Describe any medical services provided to the m inor. Date of Move Address of Residence Type of Residence Reason for Change American LegalNet, Inc. www.FormsWorkFlow.com JDF 834 SC R 9/18 - MINOR Page 4 of 7 G. Identify any special needs of the minor during this reporting period. H. Has the m Yes, explain: I. Identify any significant events involving the m inor since the last report e.g. special awards or recognition. J. Has the minor been involve d in a juvenile delinquency case or any other type of court action? Yes No If Y es , in which County? K. Does the m inor have any behavioral issues? Yes No Describe the nature of the behavioral issues and any treatment the m inor is receiving to help with the issues. L. If the minor child is not of school age, identify the stages of development for the minor child. This would include but is not limited to, if the child developed his or her motor skills (crawli ng, walking, etc.), learned to talk, and learned colors, shapes and numbers at age appropriate times. Include if the child is on track developmentally for his or her age and if not on track, explain why not and the steps taken to help the child. Does the c American LegalNet, Inc. www.FormsWorkFlow.com JDF 834 SC R 9/18 - MINOR Page 5 of 7 M. Does the m inor have any contact with the parents or other family members? Yes No Briefly describe the visits: N ame of pe rson visiting, frequency and length of visits and date of the last visit. If no visits, briefly describe why not. III. EDUCATION AND EXTRAC URRICULAR ACTIVITIES A. Is the m inor atte nding school?: Yes No If Yes, complete the information below: If No, please be sure to answer question L on page 4, Part II. Name of School : Current Grade Level: Address: Phone Number: grades are: Excellent Averag e Below Average If below average explain why . B. If the m inor is old enough, does he or she have a job? Yes No Describe . C. Describe the e ducational services provided to the minor. D. reporting period. American LegalNet, Inc. www.FormsWorkFlow.com JDF 834 SC R 9/18 - MINOR Page 6 of 7 IV. FINANCIAL MATTERS Complete this se ction only if there is no c onservatorship and the g uardian has custody of funds. A. Does the m inor own any property ? Yes No B. Do you have possession or control of the m assets , e.g. p roperty (real estate and personal property items ) , financial acc ounts? Yes No If Yes , describe the type of property and approximate value of the property : C. Do you have control of the m Income? Yes No D. If Yes , describe: Do you or the m inor rec eive any financial support f rom the biological parents or other family members ? Yes No If there is a current child support order, provide the name of the court , case number, date of mo st recent order, and status of the payments. Name of Court Case N umber State Date of Current Order Amount Payment Status e.g. on time, late E. If applicable, identify the r epresentative p ayee for Social Security and other income benefits. Name: Phone Number : F. Have any fees been paid to you i n your role as guardian? Yes No If Y es , describe: G. Have any fees been paid to others for the care of the m inor or his or her property? Yes No If Yes , describe: SUMMARY OF FINANCIAL ACTIVITY DURING REPORTING PER IOD Beginning balance of bank accounts (savings, checking, etc.) $ Plus mon i es received (social security, pension beneficiary , child support , interest, etc . ) from any source on behalf of the per son +$ Less total fees to care providers - $ Less total monies paid to the Minor , e.g. personal needs - $ Less total fees paid to guardian - $ Less any other expenses, e.g. housing, insurance, maintenance - $ Ending balance of bank accounts $ American LegalNet, Inc. www.FormsWorkFlow.com JDF 834 SC R 9/18 - MINOR Page 7 of 7 You are required to maintain supporting documentation for all receipts and all disbursements under your control during the duration of this appointment. The c ourt or any i nterested p ersons as identified in the Order Appoint ing Guardian may request copies at any time. By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. VERIFICATION I decl are under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the day of , , (date) (month) (year) at (city or ot her location, and state OR country) (printed name) (signature) CERTIFICATE OF SERVICE I certify that on (date), a copy of this (name of docume nt) was served as follows on each of the following: Name and Address Relationship to Decedent, Ward, or Protected Person Manner of Service* *Insert one of the following: hand delivery, first - class mail, certified mail, e - service, or fax. Signature NOTE: If you wish to change the persons entitled to receive copies of reports or other documents filed, you must file a separate petition with the court. American LegalNet, Inc. www.FormsWorkFlow.com
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