1 2 3 4 5 6 7 IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON IN AND FOR THE COUNTY OF KING 8 9 10 In the Guardianship of: 11 ______________________________, 12 13 An Incapacitated Person. 14 17 18 19 Case No.: PETITION FOR ORDER APPROVING GUARDIAN’S ACTIVITIES AND FINAL REPORT (FNR) PETITION AND FINAL REPORT The Guardian petitions the Court for approval of this Final Report. 15 16 ) ) ) ) ) ) ) 1.1 Guardianship History. The undersigned was appointed [ ] Full [ ] Limited Guardian of the Person (“Guardian of the Person”) and/or [ ] Full [ ] Limited Guardian of the Estate (“Guardian of the Estate”) on ___________________________________. The Guardian’s most recent report was approved on ___________________________________; and it included all activities, 20 income and disbursements through the date of __________________________________. 21 1.2 22 Incapacitated Person resided at ______________________________[facility name & 23 address], in the city or county of ______________________________. 24 1.3 25 26 Residence of Incapacitated Person: Throughout this report period, the Circumstances for Final Order. [ ] If Final Order is Due to Death of Incapacitated Person: Death of the Incapacitated Person/Last Will and Testament. The Incapacitated Person died on PETITION FOR ORDER APPROVING GUARDIAN’S ACTIVITIES AND FINAL REPORT- 1 12/2005 GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com 1 _______________. The Incapacitated Person died [ 2 there is a will, attach a copy.) The Guardian requests authority to transfer the remaining 3 Guardianship estate assets to the duty appointed or confirmed Personal Representative of the 4 5 ] with OR [ ] without a Will. (If Estate, upon receipt of a Notice of Appointment and Pendency of Probate or properly executed Affidavit of Successor. [ ] If Final Order is Due to Determination of Capacity: 6 On ______________________________, (date) the Court determined that the 7 incapacity had terminated and that there was now capacity to manage the personal care and 8 administration of assets. I was directed to transfer all Guardianship assets to the (formerly) 9 Incapacitated Person. [ ] If Final Order is Due to Removal or Resignation of Guardian: 10 On ______________________________, (date) the Court authorized the resignation or 11 removal of the Guardian herein. The Guardian requested authority to transfer the assets 12 to the duly appointed Successor Guardian upon the issuance of Letters of Guardianship 13 to said Successor. 14 1.4 15 Incapacitated Person and describing the Guardian’s activities from the conclusion of the last 16 reporting period date: ______________________________ until the [ 17 capacity OR [ 18 19 20 1.5 Care Plan. A report setting forth the medical, mental, and social information for the ] restoration of ] death of above-named Incapacitated Person is attached hereto. Current Inventory. A listing of all of the assets of the Incapacitated Person’s estate as of the date of the last reporting period: ______________________________ and of this date and their values on each date is attached hereto. 1.6 Income and Disbursement. A summary listing by categories of all income and 21 disbursements from the conclusion of the last reporting period to this date is attached hereto. 22 /// 23 /// 24 /// 25 26 PETITION FOR ORDER APPROVING GUARDIAN’S ACTIVITIES AND FINAL REPORT- 2 12/2005 GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com 1 1.7 2 liabilities from the Guardianship estate. 3 4 5 Guardian’s Fees and Costs Attorney’s Fees and Costs Other: Other: Other: Total Payments to be Authorized: 6 7 8 9 Liabilities. The Guardian requests approval to pay the following outstanding 1.8 $ $ $ $ $ $ Bond, Blocked Accounts and Other Court-Ordered Protection. At the date of termination of the Guardianship, there was $_______________ in unblocked accounts and $_______________ in blocked financial accounts. The Guardianship bond issued by 10 ______________________________ identified by bond number _______________, in the 11 amount of $_______________ (enter $0, if there was no bond in effect) should be 12 exonerated upon the filing of a receipt by the Personal Representative or Successor 13 14 15 Guardian of Incapacitated Person. 1.9 Final Tax Return. There was income for which a tax return [ ] is OR [ ] is not required. The Guardian recommends that the final tax return and tax obligations be handled as follows: ______________________________. 16 WHEREFORE, the Guardian requests an order: 17 2.1 18 Guardian; 19 2.2 20 21 22 23 Approving the Guardian’s Final Report and Accounting and the actions of the Closing the Guardianship case, discharging the Guardian, and exonerating the bond of the Guardian, upon the filing of a request for receipt of assets by the Personal Representative or Successor Guardian or previously Incapacitated Person; /// /// /// 24 25 26 PETITION FOR ORDER APPROVING GUARDIAN’S ACTIVITIES AND FINAL REPORT- 3 12/2005 GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com 1 2 2.3 3 the duly appointed or confirmed Personal Representative or Successor Guardian of the 4 5 Authorizing the Guardian to transfer the remaining assets in Guardianship estate to Incapacitated Person’s estate or the previously Incapacitated Person, upon receipt of the notification of appointment and pendency of probate or properly executed affidavit of successor. 6 7 8 I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. Signed at ________________, Washington, ___________, ____200__. 9 10 11 Signature Printed Name Address Telephone/Fax Number City, State, Zip Code Email Address 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 PETITION FOR ORDER APPROVING GUARDIAN’S ACTIVITIES AND FINAL REPORT- 4 12/2005 GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com