IN THE CIRCUIT COURT OF THE 17 TH JUDICIAL CIRCUIT WINNEBAGO COUNTY, ILLINOIS In the matter of: ) ) P ) ) an adult with a disability . A , Guardian, affirm under penalty of perjury pursuant to Section 1 - 109 of the Illinois Code of Civil Procedure that : ( Check all that apply) [ ] The Guardianship must be kept open. Status of the adult with a di [ ] The Ward remains disabled and resides at [ ] There is no estate for the Ward (this is guardianship of the person only); [ ] The Guardian does not live with the Ward, but t he Guardian visits the Ward approximately mental condition. [ ] Significant concerns or occurrences regarding the Ward : [ ] The Guardianship may be close d because . This report may be e filed prior to the assigned court date . If you are unable to efile, you may return this report with your Certifcation for Exemption from eFiling form to office, Room 108, 400 W. State Street, Roc kford, IL 61101. If the written report is timely filed, your appearance will be excused and you will receive notice of the next status date. Date: Guardian (sign): Address: Phone: Email: FILE STAMP CC 115 V4 American LegalNet, Inc. www.FormsWorkFlow.com