Name_______________________ Address _____________________ City, State, Zip ________________ Attorney for: SUPERIOR COURT OF ARIZONA, PIMA COUNTY In the Matter of the Guardianship of/ Conservatorship for: NO. ANNUAL REPORT OF GUARDIAN Date of birth: An Adult. Name of Ward Date of Birth of Ward Address of Ward Phone Number of Ward Ward’s Current Physician Physician address and phone __________________________________________ Name(s) of Guardian(s) Address(es) of Guardians(s) Relationship of Guardian(s) to Ward 1. Describe the residential situation where the ward lives (private home, boarding home, nursing home, etc.) and list the facility’s name, location and phone number ______________________________ Name and phone number of person in charge of residence: ______________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com What are the provisions made there for the ward’s care in terms of daily living needs and recreation? ____________ Are you comfortable with the care that is provided to the ward? If not, explain. 2. Does the ward attend any daily activities, work, or training programs, or have any regular weekly outings? If so, please describe them. Do you believe these activities are meeting the ward’s needs? Explain. 3. Briefly describe the medical care the ward has had in the last year. ______ When was the ward last seen by a physician? (Attach a copy of physician’s report if available or if none exists, a summary of the physician’s observations on the ward’s physical and mental condition is as follows:) __________________________________________ __________________________________________________________________ What is the ward’s current health status? 4. Have there been any substantial changes in the ward’s mental abilities or health in the last year? If so, please describe them. American LegalNet, Inc. www.FormsWorkflow.com 5. How many times did you visit the ward during the past year? you last see the ward? What date did How would you describe your relationship with the ward? ____________ 6. Do you believe the ward continues to need a guardian? Please explain. 7. Does the ward have assets, property, or annual income in excess of $5,000.00? If so, who is responsible for this money or property? Explain and list assets. 8. Does the ward receive any county services? If so, specify. ______ 9. Does the ward receive services from any other source? 10. If so, specify. Other comments or information not covered above: ______ American LegalNet, Inc. www.FormsWorkflow.com The undersigned swears that the answers set forth above are true and correct to the best knowledge and belief of the undersigned, subject to the penalties of making a false affidavit or declaration. DATED: _______________________________. Guardian’s Name Please mail original report to: Probate Clerk Superior Court of Arizona For Pima County 110 West Congress Tucson, Arizona 85701 A copy of this report must be sent to the following at least nineteen (19) days before the hearing date: the ward, the ward’s conservator, the ward’s spouse, parents (if the ward is not married), the court-appointed attorney, the guardian’s attorney, and other interested persons who have filed demands for notice. The undersigned, ___________________, states that a copy of the Annual Report of Guardian as mailed or delivered to the following persons: NAME DATE ADDRESS IDENTITY MAIL/DELIVERY DATED: Guardian’s Name American LegalNet, Inc. www.FormsWorkflow.com