PACKET BGUARDIANSHIP WITH BUDGET ANNUAL REPORTING FORMS Who may use these forms: A person who has been appointed a guardian and the court has approved a budget uses these forms to report and account to the court. What are you reporting to the court: You are reporting how the ward/incapacitated person is doing and whether you have complied with the budget for the reporting period.When are the forms to be used: You must complete the entire packet of forms and file them with the court every year from the date Letters of Appointment were issued. Your first year begins on the date Letters of Appointment are issued to you and ends one year later. You are required to file these forms each year, from that point forward. For example, if Letters of Appointment were issued to you on June 10, 2012, then your first accounting year begins June 10, 2012 and ends May 31, 2013. If these forms only are submitted and no fees are requested, then a hearing will not be automatically scheduled. A hearing will only be automatically scheduled if the court has any questions about the budget or an interested person files an objection to the accounting. If you need additional copies of this packet, forms are available on the Supreme Court website: The cost of filiSpecific Instructions: This packet includes the following: Budget Report (Pages 1-2): You complete this portion of the packet and file it with the court at the end of each year. These two pages of the packet are to include the budget as previously approved by Updated Inventory (Pages 3-4): You complete this portion of the packet by providing the amounts held in the accountAnnual Report of Guardian on Condition of Ward (Pages 5-6): You complete this portion of the packet, which includes information concerning the well-being of the ward/incapacitated person. American LegalNet, Inc. www.FormsWorkFlow.com Notice of Right to Object (Page 7): You must complete this form, file the original with the court, and mail a copy to all interested . Certificate of Mailing (Pages 8-9): By filing this Certificate with the court you are persons. You need to check the box of all of the forms/documents you have mailed to the interested persons. You must also list the names and addresses of the interested persons you sent the forms to on this form. The original must be filed with the court and copies mailed to all interested . Personal and Financial Information for Guardianships and Conservatorships (Page 10): You need to complete this form by filling in the name of the ward/incapacitated person, his or her date of birth, social security number and the name and address of all banks or other financial institutions where the ward/incapacitated person has money. You must include full account numbers on this form. This form is filed with the court only. Do not send this form to the interested . American LegalNet, Inc. www.FormsWorkFlow.com Nebraska State Court Form REQUIRED GUARDIANSHIP WITH BUDGET ANNUAL REPORTING FORMS PACKET B Page 1 of 10 CC 16:2.34 Rev. Packet B Guardianship with Budget Annual Reporting Forms IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF Ward/Incapacitated Person Case ANNUAL BUDGET REPORT, UPDATED INVENTORY, ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON, NOTICE OF RIGHT TO OBJECT, AND CERTIFICATE OF MAILING , guardian for the ward/incapacitated person named above, submits this annual report on the monthly budget previously approved by this court. This Annual Budget Report is filed for the period beginning and ending . I have filed with this Annual Budget Report a copy of the bank statement that includes the ending date and I have blacked out all but thelast four digits of bank account numbers and social security numbers on the bank statement.The budget approved by this court on was as follows:Monthly Income: Social Security ( e ither r etirement or d isability) Supplemental Security i ncome Support p ayment of a ny t ype ( e .g. a limony, c hild s upport) Wages - n ame of e mployer is (Fill in name: ) Other ( d escribe s ource) Other ( d escribe s ource) Other ( d escribe s ource) Total Inc ome Monthly Expenses: Rent and u tilities p aid to g uardian Board (food) p aid to g uardian Rent and u tilities p aid to s omeone e lse (Fill in Name: ) Board (food) p aid to s omeone e lse (Fill in Name : ) Transportation e xpense p aid to g uardian Transportation Expense p aid to so meone e lse (Fill in Name: ) Spending m oney for the w ard /incapacitated p erson Other ( d escribe p ayment) American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 10CC 16:2.34 Rev. Packet B Guardianship with Budget Annual Reporting Forms Other (Describe Payment) Other (Describe Payment) Other (Describe Payment) Total Expenses PLEASE INITIAL ONE OF THE FOLLOWING: During this period I did not /incapacitated person money than the monthly budget listed above. During this period I did money than the monthly budget listed above. Describe in detail below: PLEASE INITIAL ONE OF THE FOLLOWING: During this period I did not money than the monthly budget listed above. During this period I did money than the monthly budget listed above. Describe in detail below: PLEASE INITIAL ONE OF THE FOLLOWING: During this period I have not received any money or property on behalf of the ward/incapacitated person other than that shown on the approved budget. During this period I have received the following money or property on behalf of the ward/incapacitated person not shown on the approved budget. This includes any additional assets, gifts, awards, settlements or inheritance received during the reporting period. Describe in detail below: American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 10 CC 16:2.34 Rev. Packet B Guardianship with Budget Annual Reporting Forms UPDATED INVENTORY TO THE GUARDIAN: To protect personal information, only the last four digits of the account should be provided on this form. Complete account information is provided on the Personal and Financial Information for Guardianships and Conservatorships form. The inventory listed below is the inventory as of the ending date of this Annual Report, . 1.PERSONAL PROPERTY: Checking Accounts Bank Name Account no.XXX- $ Bank Name Account no. XXX- $ Bank Name Account no. XXX- $ Savings Accounts Bank Name Account no.XXX- $ Bank Name Account no. XXX- $ Bank Name Account no. XXX- $ Certificates of Deposit Bank Name Account no.XXX- $ Bank Name Account no. XXX- $ Bank Name Account no. XXX- $ Stocks and Bonds$ Vehicles$ Household goods and furnishings$ Other: $ TOTAL: $ American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 10 CC 16:2.34 Rev. Packet B Guardianship with Budget Annual Reporting Forms 2.JOINTLY HELD PROPERTY: With whom $ What $ With whom $ What $ TOTAL: $ 3.INCOME (Monthly): Wages - Employer name: $ Social Security $ Supplemental Security income $ Veterans Administration benefits $ Company pension $ Interest - From where: $ Dividends - From where: $ Other: $ TOTAL: $ 4.CREDIT CARD(S) belonging to ward/incapacitated person (If applicable) Card Name Account no.XXX- $ Card Name Account no. XXX- $ TOTAL: $ American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 10 CC 16:2.34 Rev. Packet B Guardianship with Budget Annual Reporting Forms ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON I, the undersigned, am the guardian of the above named ward/incapacitated person and my annual report to the court is as follows: 1.Present age of the ward/incapacitated person: 2.Current address of the ward/incapacitated person: 3. own home home nursing home hospital or medical facility foster or boarding home other: (elationship) 4.The ward/incapacitated person has lived in his or her current residence since. If the ward/incapacitated person has moved within past year, state reasons for change: 5.During the past year, how many times and on what dates did you see the ward/incapacitatedperson? 6.During the past year, remained about the same. improved. Describe: deteriorated. Describe: 7. remained about the same. improved. Describe: deteriorated. Describe: 8.During the past year, the ward/incapacitated person has been treated or evaluated by the following: Physi