PACKET AGUARDIANSHIP ANNUAL REPORTING FORMS Who may use these forms: A person who has been appointed as a guardian, who has control of any of the w property, money, assets, possessions or income (including social security or other benefits) and who has not been allowed by the court to submit a budget instead of an annual accounting uses these forms to report and account to the court each What are you reporting to the court: You are reporting how the ward/incapacitated person is doing. You are also reporting all money received by you on behalf of the ward/incapacitated person and all expenses paid by you on behalf of the ward/ incapacitated person for the reporting period. When are the forms to be used: You must complete the entire packet of forms and file them 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. If these forms only areIf you need additional copies of this packet, forms are available on the Supreme Court website: The cost of filing this pSpecific 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 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 Accounting (Pages 6-7): If ou must also provide an accountinga list of the amounts received on behalf of the ward/incapacitated person, American LegalNet, Inc. www.FormsWorkFlow.com paid out from each account on behalf of the ward/incapacitated person, to whom monies were paid and for what purpose the payments were made. You may make as many additional copies of accounting page as needed. 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 thebank or other financial institution will finish the Certificate. Complete the caseinformation on the Certificate, then take this form to the bank or other financialinstitution and ask a representative there to write in the account information, the balancein the account, and any interest paid. You should have the account balance confirmed asof the last day of the accounting. The representative from the bank or other financialinstitution must sign the Certificate in the presence of a notary public because his or hersignature must be notarized. The original Certificate(s) must be filed with the court andcopies 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 all of the forms/documents you have mailed tothe interested persons. You must also list the names and addresses of the interestedpersons you sent the forms to on this form. The original must be filed with the court anda 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,his or her date of birth, social security number and the name and address of all banks orother financial institutions where the ward/incapacitated person has money. You mustinclude full account numbers on this form. This form is filed with the court only. Donot send this form to the interested . American LegalNet, Inc. www.FormsWorkFlow.com Nebraska State Court Form REQUIRED GUARDIANSHIP ANNUAL REPORTING FORMS PACKET A CC 16:2.33 Page 1 of 13 CC 16:2.33 Rev. Packet A Guardianship Annual Reporting Forms IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF Ward/Incapacitated Person Case ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON, UPDATED INVENTORY, ACCOUNTING, CERTIFICATE OF PROOF OF POSSESSION, NOTICE OF RIGHT TO OBJECT, AND CERTIFICATE OF MAILING I, the undersigned, am the guardian 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.The w residence is: own home nursing home hospital or medical facility foster or boarding home other: (elationship) 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. mental health has: remained about the same. improved. Describe: deteriorated. Describe: American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 13 CC 16:2.33 Rev. Packet A Guardianship Annual Reporting Forms 7. physical health has: 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 is not under regular (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.As guardian, I rate the living arrangements as: 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. The w/incapacitated condition requires continuation of guardianship. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 13 CC 16:2.33 Rev. Packet A Guardianship 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 /incapacita money, assets, 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 money, assets, possessions or income (including social security or other benefits). The person who money, assets, possessions orincome (including social security or other benefits) is: AND 1)I have tal money, assets, possessions or income (including social security or otherbenefits) AND a) b) I am satisfied that the funds are being handled properly. I am not satisfied that the funds are being handled properly because . 2) I have not /incapacitatedp money, assets, possessions or income (including social security orother benefits) because . C)The ward/incapacitated person receives no money, assets, possessions or income (including social security or other benefits). American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 13 CC 16:2.33 Rev. Packet A Guardianship Annual Reporting Forms UPDATED INVENTORY TO THE GUARDIAN: To protect personal information, only the last four digits of the account should be provided on this form. Complete