PC-G-17.7A (Rev. 1-2008) PROBATE COURT OF FRANKLIN COUNTY, OHIO LAWRENCE A. BELSKIS, JUDGE IN THE MATTER OF THE GUARDIANSHIP OF CASE NO. GUARDIAN'S ANNUAL REPORT [R.C. 2111.49] The undersigned, guardian of the above-named ward, states that my annual report to the Court is as follows: Ward's age: Ward's date of birth Ward's Address: Name of Facility, if applicable Street City, State, Zip Code Telephone Number and Area Code Ward's residence is: own home group home nursing home relative's home (list name and address foster or boarding home guardian's home hospital or medical facility other If the ward resides in a facility, the name and title of the administrator or person in charge is: The ward has resided in the present residence since If the ward has moved within the last year, state the reason for the move: FRANKLIN COUNTY FORM 17.7A - GUARDIAN'S ANNUAL REPORT American LegalNet, Inc. www.FormsWorkflow.com CASE NO. Is your ward in a locked or unlocked setting? locked unlocked Is the ward restrained or has the need for restraints been presented within the past year? yes no If yes, explain: Has your ward changed to a more or less restrictive environment in the past year? no change more restrictive less restrictive Is the ward currently in the least restrictive environment for the ward's needs? yes no It is my opinion that the ward's present care is: adequate inadequate If inadequate, explain: Do you have recommendations concerning the ward's welfare? If yes, explain: How often do you personally visit your ward? daily weekly monthly yearly never Do you contact your ward in other ways? telephone mail social worker other If "other" please specify: The date of your last visit was: 2 American LegalNet, Inc. www.FormsWorkflow.com CASE NO. Are you kept informed of your ward's physical and mental condition by medical and/or human services staff? yes no If yes, please specify: During the past year, I believe the ward's physical condition has: remained the same improved deteriorated if there has been a change in the ward's physical condition, describe the change: Name of ward's physician: Physicians address: Date of ward's last visit to physician: List any public or private professionals actively involved with your ward within the past year: Check one of the following: I believe that the continuation of the guardianship is necessary. I do not believe that the continuation of the guardianship is necessary for the following reasons: 3 American LegalNet, Inc. www.FormsWorkflow.com CASE NO. Within the past year, have you developed any disabilities which hinder your duties as guardian? If yes, explain: Are you able to continue to serve as guardian? yes no The name, address, and telephone number of my attorney is as follows: Attached is a statement by a physician, clinical psychologist, licensed clinical social worker, or mental retardation team that has evaluated or examined the ward within three (3) months prior to the date of this report regarding the need for continuing the guardianship unless the court previously dispensed with the filing of a Statement of Expert Evaluation. Date Guardian's Signature . Type or Print Guardian's Name Street Address City, State, Zip Code Telephone Number - Home and Business Knowingly giving false information on a probate document is a criminal offense. [O.R.C. 2921.13(A)(11)] 4 American LegalNet, Inc. www.FormsWorkflow.com