STATE OF ILLINOIS) )SS COUNTY OF WILL ) IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY, ILLINOIS - IN PROBATE IN RE THE ESTATE OF __________________________________ Name of Minor Child A Minor CASE NO: ____________________________ ANNUAL REPORT _________________________________, by order entered ______________________, was appointed Name of guardian Date of order for guardianship plenary guardian of the person of _________________________________ and now respectfully submits the following annual report to date: A. Status of Minor 1. The address of the minor child at the time I/ We (Circle one) was/ were appointed guardian was (Circle one) _________________________________________________________________________________. 2. The minor child now lives at the following address _________________________________________________________________________________. If the ward has changed addresses, an explanation must be provided. 3. The minor's current school is _________________________________________________________. 4. The minor has health insurance through: Private insurance company _______________________________ through Name of insurance company ________________________________________________________________________ Name of person who provides minor child with insurance Illinois Medicaid Program Other: __________________________________________________________________ None 5. _______________________________________ receives food stamps on behalf of the minor child. B. Real Property (List any land, houses or real estate owned by the minor child): Address Value How Value Determined Minor has no real Property. PAMELA J. MCGUIRE, CLERK OF THE CIRCUIT COURT OF WILL COUNTY White ­ Court Yellow ­ Plaintiff 106 Part 1 of 2 (Revised 03/09) American LegalNet, Inc. www.FormsWorkFlow.com C. Personal Property (This may include items such as bank accounts, life insurance, savings bonds, college savings program, automobile(s), and cash): Minor has no personal Property. D. Expenditures from minor's money. Minor has no money for expenditures. E. Income received by minor or for minor (List in detail, including any income for the minor child from Social Security- ATTACH SEPARATE SHEET IF NECESSARY) Respectfully submitted, ______________________________________, Signature of guardian Guardian of ____________________________ Minor child VERIFICATION UPON AFFIRMATION I, __________________________________, being first duly sworn on oath, depose and state that Name of guardian I am guardian of the estate of _________________________, that I have read the foregoing Annual Report and Name of minor child Accounting, that I know the contents thereof, and that the same are true and correct to the best of my knowledge. ______________________________________ Signature of guardian Person/Attorney Who Prepared Form: Name: __________________________________________________ Address: ________________________________________________ City and Zip: ____________________________________________ Phone: _________________________________________________ ARDC #: _______________________________________________ PAMELA J. MCGUIRE, CLERK OF THE CIRCUIT COURT OF WILL COUNTY White ­ Court Yellow ­ Plaintiff American LegalNet, Inc. www.FormsWorkFlow.com 106 Part 2 of 2 (Revised 03/09)