ANNUAL GUARDIANSHIP INVESTIGATION CHECKLIST FOR PROFESSIONAL GUARDIANS AND EMPLOYEES OF PROFESSIONAL GUARDIAN S This form must be submitted annually by all professional guardians and employees of professional guardian s with a fidu c i ar y obligation to a ward. Please check all the appropriate boxes. A separate form is required for each employee . Name of Guardian Applicant /Employee Any other name (s) used by Applicant/Employee Applicant Street City S tate Zip Applicant SS# Applicant DOB Applicant Race Applicant Sex Name of Applicant Spouse Name(s) of Applicant Child(ren) To be filled out by Professional Guardians only: 1 . Investigation Checklist Yes 2 . Application for Appointment Attached Not Applicable 3 . Disclosure Statement for Not for Profit Attached Not Applicable 4 . Employee Statement Attached Not Applicable 5 . Fingerprint s Submitted electronically Waived by Court 6 . Investigation Fee in the amount of $57.50 , payable to the Broward County Clerk of Court (Includes Court Monitor/Credit Investigation fee and P rofessional Guardian p rocessing f ee . ) Attached Waived by Court 7 . Registration with the Statewide Public Yes No Guardianship Office (SPGO) 8 . A list of employees who owe a fiduciary responsibility to the W ard Yes No Not Applicable 9 . Blanket Bond Yes No Not Applicable (If yes, include a copy of the bond . ) 1 0 . Request a Copy of Court Monitor Results Yes No (If yes, submit a self - addressed , stamped envelope and a check in the amount of $1.00 payable to the Broward County Clerk of Court . ) I hereby acknowledge that I am aware of, have read, and agree to abide by the Fees and Expenses section of the 17 th time. I hereby give my consent for a background check in accordance with c hapter 744 , Florida Statutes including , but not limited to, a credit history investigation , an FDLE, FBI, employment, and Department of Children and Families background check . Under penalties of perjury, I declare that I have read the foregoing and the facts alleged are true. Applicant /Employee Signature Date Name American LegalNet, Inc. www.FormsWorkFlow.com