PACKET EGUARDIANSHIP WITH NO AUTHORITY OVER THE ESTATE OF THE WARD ANNUAL REPORTING FORMS Who may use these forms: A guardian Letters of Appointment state that the guardian has no authority over the wthe ward. If you have acquired assets on behalf of the ward, packet and you must complete Packet A instead. What are you reporting to the court: You are reporting how the ward/incapacitated person is doing. 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 For example, if Letters of Appointment were issued to you on June 10, 2012, then your first reporting period begins June 10, 2012 and ends May 31, 2013. If these forms only are submitted, then a hearing will not be scheduled automatically. A hearing If you need additional copies of this packet, forms are available on the Supreme Court website: The cost of filing this packet is $5. Specific Instructions: This packet includes the following: Annual Report of Guardian on Condition of Ward (Pages 1-3): You complete this portion of the packet to report to the court on the well-being of the ward/incapacitated person. You will file the original with the court and mail copies to the interested . Updated Inventory (Pages 4-6): You complete this portion of the packet by inserting the account balance for each bank Notice of Right to Object (Page 7): You must complete this form, file the original withthe court and mail a copy to all interested . Certificate of Mailing (Pages 8-9): By filing this Certificate with the court you are informing the court that you have mailed copies of the Annual Report You need to check the box of all of the forms/documents you have mailed to American LegalNet, Inc. www.FormsWorkFlow.com the interested persons. You must also list the names and addresses of the interested persons you mailed the forms to on this form. The original must be filed with the court and a copy 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 your 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 NO AUTHORITY OVER THE ESTATE OF THE WARD ANNUAL REPORTING FORMS PACKET E CC 16:2.37 Page 1 of 10 CC 16:2.37 Rev. Packet E Guardianship with No Authority Over the Estate of the Ward Annual Reporting Forms IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF Ward/Incapacitated Person Case ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON, UPDATED INVENTORY, NOTICE OF RIGHT TO OBJECT, AND CERTIFICATE OF MAILING 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 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. remained about the same. improved. Describe: deteriorated. Describe: American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 10 CC 16:2.37 Rev. Packet E Guardianship with No Authority Over the Estate of the Ward Annual Reporting Forms 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: Physician. Name: Psychiatrist. Name: Social or other case worker. Name: Dentist. Name: Other. Name: 9.The ward/incapacitated person is (if different than physician in #8 above) 10.Social conditions: During the past year, the ward/incapacitated person has participated in thefollowing activities: Describe. Recreational: Educational: Social: Occupational: None available. Refuses or unable to participate. 11. excellent. average. below average. If below average, explain: 12.As guardian, I believe the ward/incapacitated person is: content with living situation. unhappy with living situation. Why? 13.As guardian, I believe the ward/incapacitated person has the following needs that have not beenmet: 14.The guardianship should be continued for the following reasons: The ward/incapacitated person is still a minor. rdianship. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 10 CC 16:2.37 Rev. Packet E Guardianship with No Authority Over the Estate of the Ward Annual Reporting Forms 15.Please mark one of the following (A, B, or C) and complete the additional questions, if any, for the section you marked: A) I do possessions or income (including social security or other benefits) AND one of the following applies: 1)My accounting, certificate of proof of possession, and bank statements are filed with the court. 2)The accounting has been waived by the court. 3)A budget has been approved by the court and the Annual Budget Report is filed with the court. B)I do not assets, possessions or income (including social security or other benefits). The person whoincome (including social security or other benefits) is: AND 1)I have money, assets, possessions or income (including social security or otherbenefits) AND a)I am satisfied that the funds are being handled properly. b)I am not satisfied that the funds are being handled properly because . 2)I have not other benefits) because . C)The ward/incapacitated person receives no money, assets, possessions or income (including social security or other benefits). American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 10CC 16:2.37 Rev. Packet E Guardianship with No Authority Over the Estate of the Ward 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 5 of 10 CC 16:2.37 Rev. Packet E Guardianship with No Authority Over the Estate of the Ward 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 6 of 10 CC 16:2.37 Rev. Packet E Guardianship with No Authority Over the Estate of the Ward Annual Reporting Forms I swear or affirm, under the penalties of perjury, that I have examined the Annual Report of Guardian on Condition of Ward/Incapacitated Person and Updated Inventory, and to the best of my knowledge and belief, they are true, correct and complete. Date Signature(s) of Guardian(s) Print or Type Name of Guardian(s) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box of Guardian(s) mark if new address City/State