171P-19 (Rev. 12/11) IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS GUARDIANSHIP OF ) ) ) Case No. ) A disabled person ) ANNUAL REPORT ON WARD Now comes the Guardian of the person named in the caption hereto, under penalties of perjury as provided under Section 1-109 of the Code of Civil Procedure, stating: 1. An Order was entered on , finding said person to be a disabled adult, and appointing the undersigned Guardian of the person; 2. The last Annual Report to the Court was made on . 3. 4. The ward has no minor or adult dependent children. The ward has minor or adult dependent children. 5. the reporting period and length of stay at each place is: 6. A summary of the medical, educational, vocational and other professional services given the ward is: 7. A summary of the guardians visits with and activities on behalf of the ward is: 8. The undersigned guardian recommends continued guardianship. The undersigned guardian does not recommend continued guardianship. 9. Other information which may be useful to the Court is: All which is respectfully submitted. Date: , 20. Signature of Guardian City, State and Zip Code Prepared by: Name : Address: City State Phone: Zip Code FAX: ARDC #: American LegalNet, Inc. www.FormsWorkFlow.com