IN THE CIRCUIT COURT FOR THE THIRD JUDICIAL CIRCUIT MADISON COUNTY, ILLINOIS ) ) ) ) ) ) ) $25.00 Fee IN RE THE ESTATE OF ______________________________, Disabled Person/Minor CASE #________________________ REPORT OF GUARDIAN / ANNUAL REPORT Now comes __________________________, the Guardian of the Person and Estate of ____________________________________, and for his/her annual report to this Court states: 1. An Order was entered on ______________________, 20____, finding ______________ ______________________________, to be a disabled adult/minor, and appointing the undersigned Guardian of his/her person and/or estate. 2. This is the __________ (first, etc.) Annual Report to the Court. 3. The disabled adult/minor's current mental, physical and social condition is: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 4. The disabled adult/minor does/does not have (circle one) children or dependents. 5. The disabled adult/minor's present living arrangements and current address is: American LegalNet, Inc. www.FormsWorkFlow.com ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 6. The following is a summary of the medical, educational, vocational and other professional services provided to the disabled adult/minor during the past year: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 7. The disabled adult/minor's annual income for the past year is ______________________ and is from the following sources: a. Social Security benefits in the amount of ______________________; b. Personal earnings in the amount of ____________________________________; c. Other in the amount of ______________________________________________. 8. That from the disabled adult/minor's income, the following has been paid: a. Routine living expenses for food, shelter, utilities and transportation in the amount of _______________________________________________________; b. Medical bills in the amount of _______________________________________; c. Educational bills in the amount of ____________________________________; d. Personal funds expended by ______________________ in the amount of ______ ___________________________________________________________; and American LegalNet, Inc. www.FormsWorkFlow.com e. The disabled adult/minor's income for the year has been sufficient/insufficient (circle one) to cover all needs. Any remaining expenses have been paid by _________________________________________ (Guardian, or other source). 9. The disabled adult/minor has medical coverage through ________________________ _______________________________________________________________________. 10. It is in the disabled adult/minor's best interest that this Guardianship continues. 11. Other information that might be useful to the Court is: A.) Disabled adult/minor receives governmental benefits and the disabled adult/minor's payee for those benefits is _____________________________________________. B.) Records regarding the disabled adult/minor's income from pensions, savings, or investments. (Copies of records attached). C.) Records regarding employment income, if the disabled adult/minor is employed. (Copies of records attached). D.) Other: ______________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Dated: ______________________ ____________________________________ GUARDIAN ____________________________________ ____________________________________ ____________________________________ ADDRESS & PHONE NUMBER Subscribed and Sworn to me this _______ day of _____________________, 20______. ____________________________________ Notary Public American LegalNet, Inc. www.FormsWorkFlow.com