FORM MUST BE TYPEWRITTEN PROBATE COURT OF BUTLER COUNTY, OHIO IN THE MATTER OF GUARDIANSHIP OF Case No. GUARDIAN’S REPORT (R.C. 2111.49) NOTE: If allotted space is inadequate to respond, write "See Exhibit" in the space and add appropriate exhibit num ber and letter sequence, then attach exhibit containing inform ation requested for that space. 1 st, 1. This is the (check one) Report. 2 nd, 3 rd, 4 th, 5 th, 6 th, or , Guardian's 2. Ward's present address: City State Zip Telephone 3. W ard's living arrangem ents at the above address are best described as: a. H is or her own apartm ent or hom e (includes assisted living facilities). b. Private hom e or apartm ent of: (1) the ward's guardian. (2) a relative of the ward, whose nam e is and relationship is c. d. e. f. g. (3) a non-relative whose nam e is A foster, group or boarding hom e A nursing hom e. A m edical facility or state institution. Other (describe) If c, d, e, or f is checked, com plete the following: (1) The nam e of the hom e, facility or institution (2) The nam e of an individual at the hom e, facility or institution who has knowledge and is authorized to give inform ation to the Court about the ward. Name Telephone Number ( ) 4. The ward will be at the address given in Item 2: a. Indefinitely. b. Tem porarily. The new address and telephone num ber is: (1) U nknown. I will provide this inform ation when known. (2) City Zip State Telephone FORM 17.7 - GUARDIAN’S REPORT-PDF ( ) American LegalNet, Inc. www.USCourtForms.com 8/1/2005 Case No. 5. Guardian's contact with the ward: a. Approxim ate num ber of tim es the guardian had contact with the ward during the period covered by this report: b. The nature of those contacts (phone, personal, or other): c. Date the ward was last seen by the guardian: 6. Have you observed any m ajor change in the ward's physical or m ental condition during the period covered by this report? Yes No If "yes" is checked, briefly describe the changes: 7. The care given to the ward is If "Not Adequate" is checked, explain: Adequate 8. The guardianship should be Continued Not Adequate Not Continued If "Not Continued" is checked, explain: 9. During the period covered by this report, the ward has has not been seen by a physician. If the ward has been seen, the last date was and for the purpose of . Attached is a statem ent by a licensed physician, a licensed clinical psychologist, a licensed social worker, or a m ental retardation team , that has evaluated or exam ined the ward within three m onths prior to the date of this report regarding the need for continuing the guardianship. [R.C. 2111.49(A)(1)(i)] (Form 17.1) If an attorney has been consulted on this report: Date Attorney's Signature Guardian's Signature (Type Attorney's Name) (Type Guardian's Name) (Street) (Street) (City, State, Zip Code) (City, State, Zip Code) (Telephone Number-Include Area Code) Sup. Ct. Regis. No. (Telephone Number-Include Area Code) (Knowingly giving false information on a Probate document Is a crim inal offense.) [R.C. 2921.13(A)(11)] Form 17.7 Guardians Report - PDF - Page2 American LegalNet, Inc. www.USCourtForms.com