Annual Report Guardianship Form – Fill Out and Use This PDF

SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY

In the Matter of Guardianship for	Case Number PB:
	ANNUAL REPORT OF GUARDIAN
	DUE:			-		-
Name of the Protected Person, the WARD		Month			Date		Year

Instructions to Guardian: Arizona law (A.R.S. 14-5209(B)(5) and 14-5315), and Arizona Rules of Probate Court Procedure Rule 30(c) requires every guardian of a protected or incapacitated adult or minor to

advise the court each year regarding their Ward. Complete this report each year and file it on or before the date listed in the Order or if no date is specified, on or before the anniversary date of the “Letters of

Appointment”. When complete, mail to:

Probate Court Administration: 125 West Washington, Phoenix, Arizona 85003

You must also mail a copy of the report to anyone else who has “appeared” in the case and fill out the

Declaration of Mailing at the end of the report to show the names and addresses of all the people to whom you mailed the report and the date of mailing. Refer to the document “Instructions: How to Fill Out the Probate Court Annual Report of Guardian” to make sure you have completed this report correctly and

completely and that you have provided copies to all persons required by law.

I am the Guardian and make these statements:

1.This annual report covers the period

FROM:		-		-		TO:		-		-
	Month		Date		Year		Month		Date		Year

2.Information about the Ward, the protected or incapacitated person:

Ward’s Name:

Ward’s Date of Birth:Telephone:

Ward’s Address:

Ward’s email:

3.Information about where the Ward lives.

A.Describe the residential situation where the Ward lives (private home, boarding home, nursing home, etc.)

Case No.

B.Give the name of the facility, address, name and telephone number of the person in charge of the home or facility.

Name of Person in Charge:

Name of Facility:

Address:

Telephone Number:

Email Address:

C.PRIMARY WEEKDAY LOCATION: Monday-Friday, 8:00 A.M. TO 5:00 P.M.,

the Ward can usually be found at: (List full address below)

4.Information about the Ward’s Doctor.

Doctor’s Name:

Doctor’s Address:

Doctor’s Telephone Number:

Doctor’s Email Address:

5.Information about the Ward’s physical and mental health.

A.Date the Ward was last seen by a doctor:

B.Changes in Ward’s health. Have there been any major changes in the Ward’s physical and/or mental condition in the last year? If so, please describe the change.

C.Attach a copy of the doctor’s report about the Ward’s current physical and mental condition.

6.Information about the Ward’s Guardian.

Guardian’s Name:

Guardian’s Address:

Telephone Number:

Email Address:

7.Information about the Guardianship.

Number of times the Guardian has seen the Ward in the last 12 months:

Date of the last visit:____________

The Guardian’s opinion about whether the guardianship should continue: (Explain.)

Case No.

8.Information about the person responsible for managing the Ward’s assets:

Name:

Address:

Telephone Number:

Email Address:

9. Information about State, County or Federal Agency Services: Does the Ward

receive any state, county or federal agency services? If so, write in the name of the agency

contact and describe the services received by the Ward.

10.DECLARATION OF MAILING: I state to the Court under penalty of perjury that I mailed this Annual Report of Guardian to the following people at the following address(es) on this Month/Day/Year:___________________.

UNDER PENALTY OF PERJURY:

By signing below, I state to the Court that the contents of this Annual Report of Guardian are true and correct to the best of my knowledge and belief.

DATED:

Signature of Guardian

PRINTED Name