Annual Professional Guardianship Investigation Checklist
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Annual Professional Guardianship Investigation Checklist Form. This is a Florida form and can be use in Broward Local County.
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Tags: Annual Professional Guardianship Investigation Checklist, Florida Local County, Broward
ANNUAL PROFESSIONAL GUARDIANSHIP INVESTIGATION CHECKLIST
(including employees of a professional guardian pursuant to ยง744.3135, Fla. Stat.)
This form must be submitted annually by all professional guardians and employees of a professional guardian with
a fidicuary obligation to a ward. Please make sure to "x" or "check" the appropriate boxes.
A separate form for each employee is required.
Name of Guardian/Employee Applicant
Any other name used by Applicant/Employee
Address of Applicant
Street Address
Applicant SS#
Applicant Race
Applicant Spouse's Name
Applicant Child(ren) Names
Name of Professional Guardian Employer
1
2
3
4
5
6
7
8
9
10
11
12
City
Applicant DOB
Applicant Sex
State
Zip
Investigation Checklist
Application for Appointment
( ) Not Applicable
( ) Attached
( ) Not Applicable
Disclosure Statement for Not for Profit
( ) Attached
Employee Statement
( ) Not Applicable
( ) Attached
Fingerprint Card
( ) Waived by Court Order
( ) Attached
( ) Attached
( ) Waived by Court Order
Check payable to FDLE for $54.25
( ) Attached
Check payable to Clerk of Court for $50.00
( ) Waived by Court Order
(Court Monitor Criminal/Credit Investigation)
Check payable to Clerk of Court for $7.50
( ) Attached
(Professional Guardian Processing Fee)
( ) Yes
( ) No
Registered with SPGO
(Statewide Public Guardianship Office)
Attached is a list of employees who owe a
( ) No
fidicuary responisiblity to the ward
( ) Yes
( ) Not Applicable
Blanket Bond
( ) No
( ) Yes
( ) Not Applicable - employee
(If yes is checked, must include a copy of the bond)
( ) Yes
( ) No
Request Copy of Court Monitor Results
(If yes is checked, must include a self addressed stamped envelope and check in the amount of $1.00 payable
to Clerk of Court)
I hereby give my consent for a background check in accordance with Florida Statutes Chapter 744
to include, but may not be limited to, a check of credit, FDLE, FBI, employment, and Department
of Children & Families background.
Under penalties of perjury, I declare that I have read the foregoing and the facts alleged are true.
Applicant/Employee Signature
Date
(Effective July 1, 2008)
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