Your Name: Your Address: Your City, State and Zip Code: Your Telephone Number(s): FOR CLERKS USE ONLY / SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY In the Matter of Guardianship of: Case Number JG A Minor PERIOD FROM TO ANNUAL REPORT OF GUARDIAN DUE: MO DAY YR MO DAY YR MO DAY YR Instructions to Guardian: Arizona law (A.R.S. 14-5315) requires every guardian to submit a report to the Court each year regarding the children. Please complete this report and file with the Court on or before the ordered due date. When complete, mail the report to: Clerk of Superior Court, Juvenile Division 3131 W. Durango St., Phoenix, Arizona 85009 OR 1810 S. Lewis St., Mesa, Arizona 85210 You must also mail a copy of the report to anyone else entitled to notice, including the children if he or she is at least 14 years old, even if he or she resides with you. Fill out the Affidavit of Mailing at the end of the report to show the names and addresses of all the people to whom you mail the report and the date on which you mail it. REMINDER: YOU MUST ATTACH A DOCTOR'S RECORD, REPORT OR LETTER THAT THE CHILDREN HAVE BEEN SEEN BY A DOCTOR WITHIN THE ONE-YEAR REVIEW PERIOD. I am the Guardian and I make these statements to the Court under penalty of perjury: 1. Information about the Children. Children's Names: Street Address: City, State, Zip Code: Telephone: Date of Birth: (month, day, year) 2. Information about where the Children live. A. Describe where the Children live (private home, boarding school, etc.) ©Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED Page 1 of 4 JG92f 042313 American LegalNet, Inc. www.FormsWorkFlow.com Case No. B. Provide the information requested below about the home or facility. Name of Person in Charge or Facility: Name of Facility: Street Address: City, State, Zip Code): Telephone Number(s): 3. Information about the Children's Doctor. Current Doctor (Name): Doctor's Address: Doctor's Telephone Number: 4. Information about the Children's physical and mental health. A. B. Date the Children were last seen by a doctor: Changes in Children's health. Have there been any major changes in the Minor's physical and/or mental condition in the last year? If so, please describe the change. YOU MUST ATTACH A COPY OF A CURRENT RECORD, REPORT OR LETTER FROM A DOCTOR OR REGISTERED NURSE 5. Information about the Children's Education. a. b. c. d. Name of School District: Name/Address of School: Last Grade Completed: Describe Child(ren)'s School Experience (grades, relationships, behavior): 6. Information from the Guardian. How many times have you, the Guardian, seen the Children in the last 12 months? What was the date of the last visit? ©Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED Page 2 of 4 JG92f 042313 American LegalNet, Inc. www.FormsWorkFlow.com Case No. What is your opinion about whether the guardianship should continue? (Explain.) 7. Information about the Children's assets: A. B. Do the Children have assets greater than $5000? IF YES, has a conservatorship been ordered as required by A.R.S §14-5401 Yes Yes No No 8. Information about State, County or Federal Agency Services: Does the Minor 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 Minor. 9. Information about Children's Age and Guardianship After Age of 18: Will the Children reach the age of 18 within the next twelve months? YES NO Are the Children disabled or incapacitated to the extent that he or she will need a guardian after reaching the age of 18? YES. I believe the Minor will need a guardian after the age of 18. No. I do not believe the Minor will need a guardian after the age of 18. 10. AFFIDAVIT OF MAILING: I have mailed or will mail this Annual Report of Guardian to the following people at the following address(es) on this date: (Month/Day/Year) Name: Address: City State, Zip Code: Name: Address: City State, Zip Code: ©Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED Page 3 of 4 JG92f 042313 American LegalNet, Inc. www.FormsWorkFlow.com Case No. Name: Address: City State, Zip Code: Name: Address: City State, Zip Code: UNDER PENALTY OF PERJURY: I declare to the Court that the information I have provided in this document is true and correct to the best of my knowledge and belief. DATED: Signature of Guardian PRINTED Name of Guardian ©Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED Page 4 of 4 JG92f 042313 American LegalNet, Inc. www.FormsWorkFlow.com