IN THE CIRCUIT COURT OF THE TWENTY-SECOND JUDICIAL CIRCUIT McHENRY COUNTY, ILLINOIS Probate Division IN THE MATTER OF THE GUARDIANSHIP OF ) ) ) ) ) ) ) Case Number_______________________________ ______________________________________________ Disabled Person ANNUAL REPORT NOW comes the Guardian of the person named in the caption hereto and shows unto the Court: 1. An Order was entered on _________________________________ , finding said person to be a disabled adult, and appointing the undersigned Guardian of the person. 2. The last Annual Report to the Court was made on ___________________________________________________. 3. The ward's current mental, physical and social condition is:____________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 4. * The ward has no minor or adult dependant children. 5. The ward's present living arrangement, a description and address of every residence where the ward lived during the reporting period and length of stay at each place is:________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 6. A summary of medical, educational, vocational and other professional services given the ward is:______________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 7. A summary of the guardian's visits with and activities on behalf of the ward is:____________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 8. * The undersigned guardian recommends continued guardianship. * Check only if applicable PR-REP3: Revised 12/01/06 Page 1 of 2 Disabled Guardianship American LegalNet, Inc. www.FormsWorkflow.com 9. Other information which may be useful to the Court is:________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ All which is respectfully submitted. By: ____________________________________________________ Guardian's Signature STATE OF ILLINOIS COUNTY OF McHENRY ) ) ) SS __________________________________________________________, being first duly sworn on oath states that he/she as guardian of the above named person is authorized to execute this Report, has read the foregoing Report by him/her subscribed, knows the contents thereof and that the same are true in substance and in fact. SUBSCRIBED and sworn to before me this ______ day of ______________________, 20_____ _________________________________________________ Guardian's Signature __________________________________________ NOTARY PUBLIC PR-REP3: Revised 12/01/06 Page 2 of 2 Disabled Guardianship American LegalNet, Inc. www.FormsWorkflow.com