This report should be completed annually by the guardian or more often if directed by the court.In the matter of First, middle, and last name , an individual with a developmental disability þ Do not write below this line - For court use only Date Signature of reviewer Court action to be taken 1. þ I, en-USName (type or print)en-US , am the guardian of the individual named above, and I report for þ the period en-USDateen-US to en-USDateen-US . 2. þ Present age of the individual: en-US en-US Individual's date of birth: en-US 3. þ The current address and telephone number of the individual are: en-US þ en-US en-USCheck here if this is a new addressen-US . 4. þ The individual's present living arrangement is: þ þ own home þ þ relative's home þ en-USRelationship þ þ hospital or medical center þ þ guardian's home þ þ community placement home þ þ other: en-US 5. þ The individual has been in the present residence since en-US en-US . Descriptions and addresses of every þ residence where the individual has lived during this reporting period and the length of stay at each residence are as follows: þ þ en-US þ þ en-US 6. þ I rate the individual's present living arrangements as þ þ excellent. þ þ average. þ þ þ below average. þ en-USExplain if below average 7. þ I believe the individual is þ þ content with the living situation. þ þ unhappy with the living situation. I recommend a þ more suitable residence as follows: en-USDescribe 8. þ The individual's mental condition has þ þ remained about the same. þ þ improved. þ þ deteriorated. þ en-USDescribe the changes þ 9. þ The individual's physical health has þ þ remained about the same. þ þ improved. þ þ deteriorated. þ en-USDescribe the changes þ þ 10. þ The individual's social condition has þ þ remained about the same. þ þ improved. þ þ deteriorated. þ en-USDescribe the changes American LegalNet, Inc. www.FormsWorkFlow.com File No. 11. þ The individual has received the following services: þ þ medical. þ þ educational. þ þ vocational. þ þ other professional services. þ en-USDescribe þ en-US 12. þ My visits with and activities on behalf of the individual were: en-US þ en-US 13. þ I believe the individual has the following needs: en-US þ en-US þ en-US 14. þ I have the following questions concerning the individual or my responsibilities: en-US þ en-US þ en-US 15. þ Other information requested by the court or necessary in the opinion of the guardian is as follows: en-US þ en-US þ en-US 16. þ The guardianship þ should þ should not þ be continued because: en-US þ en-US þ en-US þ 17. þ As guardian, I have been ordered by the court to file an annual account, which is attached. 18. þ Comments: en-USDate þ en-USDate þ en-USSignature of guardian þ en-USSignature of co-guardian (if applicable) en-USAddress þ en-USAddress þ þ en-USCity, state, zip Telephone no. þ en-USCity, state, zip Telephone no. Check here if this is a new address þ Check here if this is a new address þ þ en-USI am the appointed standby guardian and am willing to continue to serve in the event the guardian dies, becomes unable to en-USserve, or resigns from the guardianship. en-USDate þ en-USSignature of standby guardian en-USAddress þ en-USCity, state, zip Telephone no. en-US Check here if this is a new addressen-USSTATEMENT BY STANDBY GUARDIAN American LegalNet, Inc. www.FormsWorkFlow.com