PACKET DGUARDIANSHIP AND CONSERVATORSHIP ANNUAL REPORTING FORMS Who may use these forms: A person who has been appointed both guardian and conservator uses these forms to report and account to the court each year. What are you reporting to the court: You are reporting how the ward/incapacitated person/protected person is doing. You are also reporting all money received by you on behalf of the ward/incapacitated person/protected person and all expenses paid by you on behalf of the ward/ incapacitated person/protected person for the reporting period. When are the forms to be used: You must complete the entire packet of forms and file them with the court every year from the date Letters of Appointment were issued. Your first year begins on the date Letters of Appointment are issued to you and ends one year later. You are required to file these forms each year, from that point forward. For example, if Letters of Appointment were issued to you on June 10, 2012, then your first accounting year begins June 10, 2012 and ends May 31, 2013. These forms are to be used when the guardian/conservator wants to submit his or her annual accounting, without requesting any fees for the guardian/conservator or anyone else. If these forms only are submitted and no fees are requested, then a hearing will not be automatically scheduled. A hearing will only be automatically scheduled if the court has any questions about the accounting or an interested person files an objection to the accounting. If you need additional copies of this packet, forms are available on the Supreme Court website: The cost of filing this packet is $10. The cost of filing this packet is $5 if an accounting is not required. Specific Instructions: This packet includes the following: Annual Report of Guardian on Condition of Ward (Pages 1-3): You complete this portion of the packet, which includes information concerning the well-being of the ward. You will file the original with the court and mail copies to the interested . Updated Inventory (Pages 4-5): You complete this portion of the packet by providing the account balance for each bank account and the account value for each brokerage account as of the last day of the reporting period. The original must be filed with thecourt and a copy mailed to all interested . Accounting (Pages 6- account(s) during the accounting period, you must also provide an accounting a list of the amounts received on behalf of the American LegalNet, Inc. www.FormsWorkFlow.com ward/incapacitated person/protected person, the amounts paid out from each account on behalf of the ward/incapacitated person/protected person, to whom monies were paid and for what purpose the payments were made. You should end the accounting on the same date that the accounting year ends. The original form must be filed with the court along with copies of all bank statements, brokerage statements, etc. covering the accounting period with all but the last four digits of account numbers and social security numbers blacked out. You will mail copies to the interested . Certificate of Proof of Possession (Pages 8-9): You will need one Certificate for each bank or other financial institution. You will begin a portion of the Certificate, but the bank or other financial institution will finish the Certificate. Complete the case information on the Certificate, then take this form to the bank or other financial institution and ask a representative there to write in the account information, the balance in the account, and any interest paid. You should have the account balance confirmed as of the last day of the accounting. The representative from the bank or other financial institution must sign the Certificate in the presence of a notary public because his or her signature must be notarized. The original Certificate(s) must be filed with the court and copies mailed to the interested . Notice of Right to Object (Page 10): You must complete this form, file the original with the court and mail a copy to all interested . Certificate of Mailing (Pages 11-12): By filing this Certificate with the court you are informing the court that you have mailed copies of the forms listed sted the interested persons. You must also list the names and addresses of the interested persons you sent the forms to on this form. The original must be filed with the court and a copy mailed to all interested . Personal and Financial Information for Guardianships and Conservatorships (Page 13): You need to complete this form by filling in the name of your ward/incapacitated person/protected person, his or her date of birth, social security number and the name and address of all bank or other financial institutions where the ward/incapacitated person/protected person has money. You must include full account numbers on this form. This form is filed with the court only. Do not send this form to the interested . American LegalNet, Inc. www.FormsWorkFlow.com Nebraska State Court Form REQUIRED GUARDIANSHIP AND CONSERVATORSHI P ANNUAL REPORTING FORMS PACKET D CC 16:2.36 Revised Page 1 of 13 CC 16:2.36 Rev. Packet D Guardianship and Conservatorship Annual Reporting Forms IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATEDWard/Incapacitated Person/Protected Person Case PERSON/PROTECTED PERSON, UPDATED INVENTORY, ACCOUNTING, CERTIFICATE OF PROOF OF POSSESSION, NOTICE OF RIGHT TO OBJECT, AND CERTIFICATE OF MAILING I, the undersigned, am the guardian and conservator of the above named ward/incapacitated person and my annual report to the court is as follows: 1.Present age of the ward/incapacitated person: 2.Current address of the ward/incapacitated person: 3. own home nursing home hospital or medical facility foster or boarding home other: (Relationship) 4.The ward/incapacitated person has lived in his or her current residence since. If the ward/incapacitated person has moved within past year, state reasons for change: 5.During the past year, how many times and on what dates did you see the ward/incapacitatedperson? 6. remained about the same. improved. Describe: deteriorated. Describe: American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 13 CC 16:2.36 Rev. Packet D Guardianship and Conservatorship Annual Reporting Forms 7. remained about the same. improved. Describe: deteriorated. Describe: 8.During the past year, the ward/incapacitated person has been treated or evaluated by the following: Physician. Name: Psychiatrist. Name: Social or other case worker. Name: Dentist. Name: Other. Name: 9.The ward/incapacitated person is (if different than physician in #8 above) 10.Social conditions: During the past year, the ward/incapacitated person has participated in thefollowing activities: Describe. Recreational: Educational: Social: Occupational: None available. Refuses or unable to participate. 11. excellent. average. below average. If below average, explain: 12.As guardian, I believe the ward/incapacitated person is: content with living situation. unhappy with living situation. Why? 13.As guardian, I believe the ward/incapacitated person has the following needs that have not beenmet: 14.The guardianship should be continued for the following reasons: The ward/incapacitated person is still a minor. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 13 CC 16:2.36 Rev. Packet D Guardianship and Conservatorship Annual Reporting Forms 15.Please mark one of the following (A, B, or C) and complete the additional questions, if any, for the section you marked: A) I do possessions or income (including social security or other benefits) AND one of the following applies: 1) My accounting, certificate of proof of possession, and bank statements are filed with the court. 2) The accounting has been waived by the court. 3) A budget has been approved by the court and the Annual Budget Report is filed with the court. B) I do not assets, possessions or income (including social security or other benefits). The person who income (including social security or other benefits) is: AND 1) I have money, assets, possessions or income (including social security or other benefits) AND a) I am satisfie