Instructions Clear Form THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Guardianship of Case Name: Case Number: (if known) REPORT OF THE GUARDIAN OF THE PERSON - MINOR 6-month Report Annual Report Other REPORTING PERIOD: 1. Telephone Guardian Name Mailing Address Guardian Name Telephone Mailing Address 2. Minor Name Telephone Mailing Address Residence Address Type of facility 3. Telephone Name of Institution (if minor is institutionalized) Mailing Address 4. Physical health of minor Significant changes since last report 5. Hospitalization(s) since last report Surgical procedure(s) since last report Illness(es) since last report 6. Mental health of minor Psychiatric treatment(s) since last report NHJB-2170-FP (02/04/10) (formerly AOC-223-003 – Annual; AOC-223A-003 – 6-month; AOC-223-008) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Guardianship of Case Number: REPORT OF THE GUARDIAN OF THE PERSON – MINOR 7. Has there been any change of living conditions of the minor since the last report? Yes No If yes, please explain. 8. If the minor lives with the guardian, list the names and addresses of any adults who are new to the home since the last report. Those persons must complete a Criminal Record Release Authorization form and a DHHS Record Release Authorization form and file with the court. 9. Has there been any change in the financial status of the minor since the last report? Yes 10. No If yes, please explain. Name of present school attended by the minor Grade Are there any special educational issues that have arisen since the last report? If so, please explain. 11. Provide any other information related to the well-being, behaviors, and care of the minor that may assist the court to better assess the general welfare of the minor. Date Guardian Signature Date Guardian Signature READ AND NOTED Date Marital Master Date Judge NHJB-2170-FP (02/04/10) (formerly AOC-223-003 – Annual; AOC-223A-003 – 6-month; AOC-223-008) Page 2 of 2 Top of 1st Page American LegalNet, Inc. www.FormsWorkFlow.com