FOR CLERK’S USE ONLY 908790879078908790 0790798 )078( JKL;KJL;KJL;JKL;KJL JKL;JKL;KJL ;J;J;JKL Name of Person Filing: _______________________________________ Mailing Address: _______________________________________ City, State, Zip Code: _______________________________________ Day/Evening Telephone: _______________________________________ Attorney Bar Number (if applicable) __________________________________ Self, Without a Lawyer, OR Representing: Attorney for _________________________________  L;KJL;JKL;KJL;JKL;JKL SUPERIOR COURT OF ARIZONA MOHAVE COUNTY ;JKL;JKL;JLK Case No. ______________________________ In the Matter of the Guardianship of ANNUAL REPORT OF GUARDIAN FOR A MINOR L;KJL;KJL;JKL;JKL ___________________________________ A Minor 33 /30 /30 22 /20 /20 TO:_______________ Month / Day / Year 44 /40 /40 PERIOD FROM:_______________ Month / Day / Year DUE:_______________ Month / Day / Year Instructions to Guardian: Arizona law (A.R.S. 14-5315) requires every guardian of a minor to advise the Court each year regarding the minor. Please complete this report each year on the anniversary date of your appointment as guardian. When complete, mail the report to: Clerk of Superior Court, Mohave County Courthouse, P.O. Box 7000, Kingman, AZ 86402 You must also mail a copy of the report to anyone else who has appeared in the case. You must mail a copy to the Minor, if he or she is at least 14 years old. You must also 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 mailed the report and the date on which you mailed it. (If necessary, additional pages may be attached.) I am the Guardian and make these statements: Information about the Minor. Minor’s Name: 0780970 )789( JKL;KJL;JL;J;K; JHGJKGKLHJK L;KJL;KJL;JKL;JKL 1. _______________________________________________________________________ Street Address: _______________________________________________________________________ City, State, Zip Code ___________________________________________________________________ 2. ________________________ 55 /50 /50 Telephone: Date of Birth:________________ Month / day / year Information about where the Minor lives. A. Describe the residential situation where the minor lives (private home, boarding school, etc) ;JKL;KJL;HJK ______________________________________________________________________________ Provide the information requested below about the home or facility. 6456A467 )567( GJHGKJHLKJKL; JKL;JKL;J L;JKL;JK L;JKL;JKL;LKJKL;JK B. Name of person in charge:_________________________________________________________ Name of facility: Street Address: City, State, Zip Code: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Telephone Number(s): ___________________________________________________________ Revised: 2/25/11 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com ;JKL;JKL;JLK Case No.________________________________ 3. Information about the minor’s doctor. Minor’s Current Doctor’s Name: ___________________________________________________________ Doctor’s Address: Doctor’s Telephone Number: 4. ___________________________________________________________ ___________________________________________________________ Information about the minor’s physical and mental health. A. Date the minor was last seen by a doctor:_____________________________________________ B. Major changes in the minor’s physical and/or mental condition in the last year as observed by the guardian. (Please describe any change(s) below): ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ C. 5. Attach a copy of the doctor’s report about the minor’s current physical and mental condition. Information about the minor’s education. Name of School District: _________________________________________________________________ Name/Address of school: ________________________________________________________________ Last grade completed: __________________________________________________________________ Describe minor’s school experience (grades, relationships, behavior):_____________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 6. Information about the guardianship. Number of times the guardian has seen the minor in the last 12 months:____________ Date of last visit: ______________. The guardian’s opinion about whether the guardianship should continue: (Explain.) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 7. Information about the person responsible for managing the minor’s assets: Name:________________________________________________________________________________ Street Address:_________________________________________________________________________ City, State, Zip:_________________________________________________________________________ Telephone Number(s):___________________________________________________________________ 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.___________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Revised: 2/25/11 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com ;JKL;JKL;JLK Case No.________________________________ 9. Respectfully submitted this ___________ day of _______________, 20____. _____________________________________ Print Guardian’s Name 10. _________________________________ Signature of Guardian AFFIDAVIT OF MAILING: Under penalty of perjury, I state to the Court that I have mailed or will mail a copy of 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________________________________________________________________ Name: ________________________________________________________________________ Address: ________________________________________________________________________ City, State, Zip Code________________________________________________________________ Name: ________________________________________________________________________ Address: ________________________________________________________________________ City, State, Zip Code________________________________________________________________ 11. Signature of person mailing the document __________________________________________________ Revised: 2/25/11 Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com