Stacey Kemp
Collin County Clerk
Probate Department
2100 Bloomdale Road, Suite 12360
McKinney, Texas 75071
(972)424-1460 Ext. 6463
(972)548-6463
Annual Report of Guardian of the Person
Pursuant to Texas Probate Code § 743, a person appointed as Guardian of the Person of an Incapacitated person is required to file an Annual Report on the well being of that Incapacitated person. The following form can be used to comply with this requirement.
Instructions:
Form must be filled out completely and to the best of your knowledge.
If you are unsure of your Cause Number, Reporting time period, or Bond type please call the Probate Office at at 972-548-6463 for assistance.
Reporting time period should always cover the previous year.
All guardians appointed Guardian of the Person need to be included in the report.
All guardians must sign the report in front of a Notary Public.
.
Attach a current picture of the ward.
Reports may be filed in person or by mail along with any applicable fee.
Unless there is an Affidavit of Indigence or Affidavit of Inability to Pay on file, the fee to file the Report is $12.00 and the fee for renewed Letters of Guardianship is $8.00.
Failure to file the required Annual Report in a timely manner could result in the setting of a hearing before the court and/or the abatement of the guardian’s authority.
PLEASE NOTE: THIS FORM IS NOT A SUBSTITUTE FOR LEGAL ADVICE
Annual Report of Guardian of the Person
Page 1 of 6
Cause No. ________________________
GUARDIANSHIP OF |
§ |
IN THE PROBATE COURT |
__________________________ |
§ |
NUMBER 1 |
AN INCAPACITATED PERSON |
§ |
COLLIN COUNTY, TEXAS |
ANNUAL REPORT OF GUARDIAN OF THE PERSON
Now comes ______________________________________, Guardian(s) of the person of
_________________________________ (Ward’s name), and presents the following annual
report covering the time period of _________________ to __________________.
1.Guardian’s name and current address:
_____________________________________________________________________
_____________________________________________________________________
Phone number: ________________________________________________________
Email: _______________________________________________________________
2.Ward’s name and current address:
_____________________________________________________________________
_____________________________________________________________________
Phone number: ________________________________________________________
How long at this address? _______________________________________________
Ward’s age: ____ Date of Birth: ________ SSN: XXX-XX-_____ (last 4 digits only)
3. The ward lives in: (a) own home ____ (b) guardian’s home ___ (c) foster home ___ (d)
relative’s home (describe relationship) __________________________________ (e)
Hospital or Medical Facility (name & address) ____________________________
_____________________________________________________________________ (f)
Other (specify) _____________________________________________________
4.Has the ward’s residence changed within the past year? Yes ___ No ___ If so, state the date and reason. ____________________________________________________
_____________________________________________________________________
5.If the ward does not live with you, please state the number of times you have visited the ward in the past year. _________ Date of last visit _________________________
PLEASE NOTE: THIS FORM IS NOT A SUBSTITUTE FOR LEGAL ADVICE
Annual Report of Guardian of the Person
Page 2 of 6
6.Does the ward have an estate other than nominal sums of money and personal effects?
Yes _____ No _____
Do you have possession of the ward’s estate? Yes ____ No _____
During the past year _______________________ (guardian or caregiver) has received and spend funds for the care and maintenance of the ward as described below. (state all funds received from all sources, including social security or welfare)
1.Total funds received annually: ______________________________________
2.Source of funds:_________________________________________________
3.Total funds spent for ward’s care: ___________________________________
4.Who has possession or control of ward’s estate? (name and address)
_______________________________________________________________
7.The ward’s physical health has:
Improved ____ Deteriorated ____ Remained Unchanged ______
The ward’s mental health has:
Improved ____ Deteriorated ____ Remained Unchanged ______
If the ward’s condition has changed, please describe all changes.
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________
8.During the past year has the ward had regular medical care? Yes ____ No _____
The ward should have, at least, an annual checkup with the doctor. If the ward has not
had an annual checkup, please list the reasons why.
_____________________________________________________________________
The ward’s present physician is:
Name: _______________________________________________________________
Address: _____________________________________________________________
Phone Number: _______________________________________________________
During the past year has the ward received treatment or evaluation by a doctor other than an annual checkup? Yes ___ No ____
Name: _______________________________________________________________
Address: _____________________________________________________________
Treatment Involved: ____________________________________________________
________________________________________________________________________
__________________________________________________________________
During the past year has the ward received treatment or evaluation by a psychiatrist, psychologist, or other mental health provider? Yes ____ No ____
Name: _______________________________________________________________
Address: _____________________________________________________________
Treatment Involved: ____________________________________________________
________________________________________________________________________
__________________________________________________________________
PLEASE NOTE: THIS FORM IS NOT A SUBSTITUTE FOR LEGAL ADVICE
Annual Report of Guardian of the Person
Page 3 of 6
9.The ward should have, at least, an annual checkup with a dentist
Give the date of the ward’s last annual checkup. ______________________________
If the ward has not had an annual checkup, please list the reasons why.
________________________________________________________________________
__________________________________________________________________
The ward’s present dentist is:
Name: _______________________________________________________________
Address: _____________________________________________________________
Phone: ______________________________________________________________
During the past year has the ward received any other treatment or evaluation by a dentist other than an annual checkup? Yes ____ No ____
Name: _______________________________________________________________
Treatment Involved: ____________________________________________________
________________________________________________________________________
__________________________________________________________________
10.During the past year has the ward seen a Social Worker or other case worker? Yes ____ No ____
Name: _______________________________________________________________
Treatment Involved: ____________________________________________________
________________________________________________________________________
__________________________________________________________________
11.During the past year has the ward seen another individual who provided treatment? Yes ____ No ____
Name: _______________________________________________________________
Treatment Involved: ____________________________________________________
________________________________________________________________________
__________________________________________________________________
12.Briefly describe all recreational, educational, occupational, and social activities in which the ward has participated during the past year. If the ward is unable or has refused to participate, please state so. ______________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________
13.The ward’s present living arrangements are:
Excellent _______ Average ________ Below Average ________
If below average, please explain: __________________________________________
________________________________________________________________________
__________________________________________________________________
PLEASE NOTE: THIS FORM IS NOT A SUBSTITUTE FOR LEGAL ADVICE
Annual Report of Guardian of the Person
Page 4 of 6
14.Is the ward content or unhappy with the living arrangements? ___________________
_____________________________________________________________________
15.Are there any unmet needs of the ward? ____________________________________
_____________________________________________________________________
16.Should your powers or duties be:
Increased ____ Decreased ____ Remain Unchanged ____
If change is recommended, please state change and reasons: ____________________
________________________________________________________________________
__________________________________________________________________
17.If there is any additional information you wish to share with the court please state or attach to this report. ____________________________________________________
________________________________________________________________________
__________________________________________________________________
18.If the Bond in this guardianship is a corporate surety bond, has the bond premium for the next reporting year been paid? Yes ____ No ____ N/A ____
If the Bond in this guardianship is a personal surety bond, has there been a change in the status of the sureties on the bond? (ex: address, death, financial)
Yes ___ No ___ N/A ___ If so, please explain. _______________________________
_____________________________________________________________________
The current bond is a personal bond. Yes ___ No ____ N/A ____
19.Please include a current photograph of the ward for the court’s records.
|
OATH OF GUARDIAN |
STATE OF TEXAS |
} |
COUNTY OF COLLIN |
} |
Before me, the undersigned authority, on this date personally appeared
__________________________________________, Guardian(s), who being first duly
sworn, states on oath that the foregoing report is a true, correct, and complete statement of the present condition, welfare, and well being of ______________________________, an
Incapacitated Person, as of the date stated herein.
Signed:___________________________________
Guardian Signature
Signed:___________________________________
Guardian Signature
SWORN TO AND SUBSCRIBED BEFORE ME ON THIS ____ DAY OF _______,
20____.
____________________________________
Notary Public in and for the State of Texas
PLEASE NOTE: THIS FORM IS NOT A SUBSTITUTE FOR LEGAL ADVICE
Annual Report of Guardian of the Person
Page 5 of 6
ATTACH WARD’S CURRENT PICTURE HERE
Please Use Clear Tape Only
Do Not Use Staples
PLEASE NOTE: THIS FORM IS NOT A SUBSTITUTE FOR LEGAL ADVICE
Annual Report of Guardian of the Person
Page 6 of 6
