700-00093 Annual Personal Status Report for Minor (0/201) Page 1 of 3 STATE OF VERMONT SUPERIOR COURT PROBATE DIVISION Unit Docket No. In re Guardianship of : T he following is a report to the C ourt concerning : Name of Minor for the period beginning and ending I hereby state under oath that the following fac ts are true concerning the minor who is under my guardianship. 1. Minor address : Mailing Address Physical Address (if different) The minor resides (check one): At my home. Other (describe) 2. Minor current health , development and health care needs: ( describe any strengths and concerns and all aspects o f health care for the minor, including his/her physical health, mental health and dental care.) 3. Other Services Received and I nvolvement with Department f or Children and Families or the Courts ( describe any services the minor has received other than those described in item 2 above and any i nvolvement with the Department f or Children and Families or the Courts) Physical Address (if different) of Minor American LegalNet, Inc. www.FormsWorkFlow.com 700-00093 Annual Personal Status Report for Minor (0/201) Page 2 of 3 4. Minor al activities and progress : ( include name of any school, day care or early education program attended by minor; the minor achievements.) 5. ( D escribe contact between minor and including frequency and duration of contact and whether contact was supervised. Describe degree to which parents are involved in decisions about minor.) 6. My activitie s as guardian for the minor : (Describe the manner in which you have carried out your 7. challenges as well as any areas of concern to you) American LegalNet, Inc. www.FormsWorkFlow.com 700-00093 Annual Personal Status Report for Minor (0/201) Page 3 of 3 8. Minor I am am not managing the minor ial assets other than Social Security benefits . If you are , an annual summary of account must be filed with this report. I have attached a co py of the most recent report to Social Security regarding the 9. Recommendations for changes to Guardianship Order: I recommend that the G uardianship O rder be changed: Y es N o If yes, attach a request to modify , amend or terminate Guardianship Order. Date Signature of Guardian Guardian Guardian : Email Address: Date Signature of Co - Guardian Co - Co - : Co - Email Address: Signed and sworn to before me: Date Signature of Notary Public Expiration Date American LegalNet, Inc. www.FormsWorkFlow.com