Notice of Employees Professional Guardian and/or Entity: ______________________________ Address:_____________________________________________________ City: ____________________________ State ______________________ Zip Code: ________________________ Telephone:__________________ E-Mail address:_______________________________________________ No Employees As of ____________(date) the following individuals have a fiduciary responsibility to a ward for whom I am guardian and attached is the DCF release form for each. Name: ___________________________________________________ Date hired: _____________ Duties Performed:___________________________________________ Name: ___________________________________________________ Date hired: _____________ Duties Performed: ___________________________________________ Name: ___________________________________________________ Date hired: _____________ Duties Performed: ___________________________________________ If there are more than three employees please attach the above information for each employee to this notice. I agree to submit an amendment to the above information within 15 days of termination an employee or hiring of a new employee. Under penalties of perjury, I declare that I have read the foregoing and the facts alleged are true to the best of my knowledge and belief. Guardian Signature:_______________________________________ Date:___________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com