IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT____________________ In the Matter of the Protective Proceedings of: ) ) Name of Ward: ) ) Date of Birth: ) ) ) Residential location of ward: ) ) Ward's Telephone #: ) ) CASE NO. FINAL GUARDIANSHIP REPORT Instructions To Guardian Please type or print clearly using black ink. In preparing the report, you must consult with the ward as much as possible (if the ward is still living). The court will treat the information in this report as confidential. If you are unable to complete this form without help, you may find assistance on the website of the Office of Public Advocacy (OPA): http://doa.alaska.gov/opa/pg/pub_guard.html. Your local library and court may also have a binder of helpful information entitled "Family Guardian Education Materials," prepared by the Alaska State Association for Guardianship and Advocacy. You may also call OPA at 269-3500 (in Anchorage), 451-5933 (in Fairbanks) or 1-877-957-3500. After completing this report, you must sign it under oath (or affirmation) in the presence of a notary public or court clerk. See last page. If you were a full guardian with the powers of a conservator, you must fill out the entire form. If you were a partial guardian and did not have the powers of a conservator (or if a separate conservator was appointed), you do not need to fill out the financial information in paragraphs 10 through 17. The purpose of this report is to tell the court why your service as guardian is ending and what has happened to the ward and the ward's assets since you filed your last annual report. Reporting Period This report covers the period: From the end of the last reporting period: To the date my services as guardian ended: Information About Guardian Guardian's Name Mailing Address (box or street number) Check here if this mailing address is new. Relationship to ward: Page 1 of 12 PG-215 (4/17)(cs) FINAL GUARDIANSHIP REPORT Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f) AS 13.26.276 - .286, .510, .570 & 13.06.100 American LegalNet, Inc. www.FormsWorkFlow.com Daytime Phone (city) (state) (ZIP) In what areas did you have the authority to make decisions for the ward? housing medical care school & job training employment social & recreational activities financial management (you controlled ward's finances because you had conservator powers) Was a separate conservator appointed for the ward? No Yes Name: Reason For Ending Guardianship My guardianship of the ward has ended because: The ward died on (date) at (location) A copy of the death certificate is attached. I did did not have possession of the ward's will. On , 20 , I delivered the ward's will to the court for safekeeping, as required by AS 13.26.545(e), and informed the executor or a beneficiary named in the will that the will had been so delivered. Name of person notified: , has been appointed. (name) I resigned as guardian. A new guardian, I was removed by the court. The court has terminated the guardianship because Other (Explain): If the ward is deceased or if the guardianship has been terminated because the ward regained capacity, you need not fill out paragraphs 1-9. Skip to paragraphs 10-17. You must fill out paragraphs 10 - 17 if you were a full guardian with authority to manage the ward's finances. If you did not have financial management authority, skip to the signature section on the last page. Information About Ward 1. Housing. a. Where does the ward live now (name of facility or place)? Who takes care of the ward? nursing home Type of Residence: Page 2 of 12 PG-215 (4/17)(cs) FINAL GUARDIANSHIP REPORT assisted living home Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f) AS 13.26.276 - .286, .510, .570 & 13.06.100 American LegalNet, Inc. www.FormsWorkFlow.com b. What is the ward's opinion of the ward's current living arrangements? 2. Medical Care. a. Which of the following medical professionals has the ward seen since the last report to the court? Doctor's Name Phone No. Dates Seen Medical Doctor Dentist Eye Doctor Ear Doctor Psychologist or Psychiatrist Other: b. Describe any medical services and mental health treatment provided to the ward since the last report to the court: c. Are there any problems providing medical care or treatment for the ward? d. e. Is a no-code (Do Not Resuscitate) provision in place for the ward? Yes No Did the ward, while the ward still had the capacity to do so, execute a durable power of attorney for health care or some other advance health care directive Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f) AS 13.26.276 - .286, .510, .570 & 13.06.100 American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 12 PG-215 (4/17)(cs) FINAL GUARDIANSHIP REPORT under AS 13.52.010 - .395 or another law? Yes No. If yes, who is the agent authorized to make health care decisions for the ward? 3. School and Job Training. Since the last report to the court, did the ward attend school or receive any type of job training? No Yes. Describe studies (include name and location of school): 4. Work. Was the ward employed at any time during the period since the last report to the court? No Yes. Describe (include type of work, name of employer, address, phone, and how long employed): 5. Contacts With Ward. a. If the ward did not live with you, how often did you visit the ward in the period since the last report to the court? b. Were there any other contacts? Type of Contact by telephone by mail or e-mail through 3rd person: other: No Yes, as follows: How Often 6. Decision Making. Have there been any changes in the ward's ability to make decisions about matters affecting the ward's health and safety? 7. Community Resources (service providers, churches, government programs, charitable organizations, etc.). List the community organizations that are currently involved with the ward. Name of Organization Services Received Agency Phone Page 4 of 12 PG-215 (4/17)(cs) FINAL GUARDIANSHIP REPORT Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f) AS 13.26.276 - .286, .510, .570 & 13.06.100 American LegalNet, Inc. www.FormsWorkFlow.com 8. Significant Actions. Describe any significant actions you took as guardian for the ward during the period since your last report was filed with the court: 9. Additional Information. List any additional information about the ward that you wish to report to the court: You only have to fill out paragraphs 10 ­ 17 if you were a full guardian with authority to manage the ward's finances. If you did not have financial management authority,