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Report Of Guardian Ad Litem Form. This is a Washington form and can be use in King Local County.
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Tags: Report Of Guardian Ad Litem, 51, Washington Local County, King
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IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON
IN AND FOR THE COUNTY OF KING
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) Case No.:
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) REPORT OF GUARDIAN AD LITEM
)
) (RTGAL)
)
In the Guardianship of:
____________________,
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An Alleged Incapacitated Person.
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RECOMENDATIONS
I (do not ) recommend that the Court appoint __________, as the (limited)
guardian of the person and (limited) guardian of the estate of the AIP.
I (do not) recommend a bond or blocked account because the assets of the AIP are
___________________________________________.
I recommend that reports be filed on a ________basis.
I recommend that the AIP retains (does not retain) the right to vote.
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1. Appointment:
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Date of Appointment:
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Date of Service of Copy of Petition on Guardian ad Litem:
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Date Guardian ad Litem’s Statement of Qualifications was filed & served:
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Date of Service of Notice of Guardianship Petition on AIP:
I attest that I am free from influence by anyone interested in the results of these
proceedings and that I have the requisite knowledge, training, and expertise to perform the
duties required by statute. My Statement of Qualifications is on file with the Court. I attest
that I am on the Guardian ad Litem Registry for King County and am qualified to serve as
Guardian ad Litem in guardianship matters.
GUARDIAN AD LITEM REPORT - 1
2005 REVISED GUARDIANSHIP FORMS
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2. Precipitating Issues:
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3. Personal Information Regarding Alleged Incapacitated Person:
Date of Birth (optional):
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Age:
Current Residence:
Phone Number:
4. Medical/Psychological Report: I obtained a Medical/Psychological Report from
________ on __________,___ 200__. (NOTICE: The Medical/Psychological Report should
be filed separately with the Court under seal, NOT as an Exhibit to this Report.)
5. Meeting with AIP:
Date(s) of Meetings with
Alleged Incapacitated
Person
Location of Meeting
Other Persons Present
(GAL must meet alone at
least once with AIP.)
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Agreement or objection to appointment of a Guardian:
Reaction to the proposed Guardian:
Right to counsel:
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Preferences regarding choice of counsel:
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Right to a jury trial:
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(Notes from the interview.)
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GUARDIAN AD LITEM REPORT - 2
2005 REVISED GUARDIANSHIP FORMS
American LegalNet, Inc.
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INVESTIGATION
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6. Written Material Reviewed: I have reviewed the Medical/Psychological Report,
______, _________, and the pleadings and records on file.
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7. Individuals Interviewed: During the course of my investigation, I interviewed the
following person(s):
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Name
Date(s) of Contact
Relationship to AIP
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Investigation re the AIP’s ability to manage health, safety, nutrition and housing.
Health: (Notes from interviews)
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Housing: (Notes from interviews)
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Nutrition: (Notes from interviews)
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Safety: (Notes from interviews)
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Investigation re: the AIP’s ability to manage finances: (Notes from interviews)
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Investigation re: who is the appropriate guardian for the AIP: (Notes from interviews)
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8. Nature, Cause and Degree of Incapacity - Functional Limitations: The following is a
description of the nature, cause, and degree of incapacity, and the basis upon which this
judgment is made:
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Medical Diagnosis and Cause:
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Degree of Incapacity:
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9. Evaluation of Proposed Guardian(s):
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Dates of Contact Between GAL and Proposed Guardian(s):
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Identity and Contact Information of the Proposed Guardian(s):
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Name:
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Mailing Address:
Telephone Number:
Fax Number:
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Email Address:
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If Guardian is Certified,
Provide Certification No.:
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GUARDIAN AD LITEM REPORT - 3
2005 REVISED GUARDIANSHIP FORMS
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Description of Steps Proposed Guardian Has, or Intends, to Take to Meet the Needs of the
AIP:
10. Alternatives to Guardianship:
11. Degree of Assistance Required:
12. Recommendation as to Appointment of Guardian:
13. Duration and Limitations:
14. Recommendation Regarding AIP’s Right to Vote:
15. Recommendation Regarding Right to Jury Trial:
16. Recommendation Regarding Appointment of Independent Counsel:
17. Estimate of Estate. The assets, funds, and income of AIP are as follows:
Value ($)
Real property
$
Stocks, Mutual Funds and Bonds
$
Mortgages and Notes
$
Bank Accounts
$
Furniture and Household Goods
$
Other Personal Property
$____________
Total Approx. Value of Assets
$
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Social Security Benefits
Washington State Assistance
Other
Total Approx. Monthly Income
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18. Recommendation Regarding Bond/Annual Reports:
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[
]
The Court should set bond in the amount of $________________.
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[
]
The Court should block or restrict access to the following assets:
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_________________.
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[
]
$
$
$____________
$
The Guardian should file reports
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] an annual report for the first year and then every third year
///
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] every third year
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] every other year
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] every year
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///
GUARDIAN AD LITEM REPORT - 4
2005 REVISED GUARDIANSHIP FORMS
American LegalNet, Inc.
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19. Recommendation Regarding Presence of AIP at Hearing:
The presence of the Alleged Incapacitated Person
[
] should
[
] should not
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be waived. ______________________________ is
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[
] able
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[
] unable
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to attend the hearing. (If unable to attend, please explain the reason(s)):
_______________________________________________________________________.
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The following special arrangements should be made for the hearing (i.e., removal of hearing
site to residence of Alleged Incapacitated Person, provision for hearing assistive devices,
etc.).
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20. Other Recommendations:
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21. Recommendation as to Guardian ad Litem’s Continuing Involvement in Future
Proceedings:
I recommend that the Guardian ad Litem
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[
] be
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[
] not be
involved in future proceedings in this matter.
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22. Individuals Who Should Be Advised of Their Right to Request Special Notice of
Proceedings Pursuant to RCW 11.92.150:
Name, Title and Address
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Relationship to Alleged Incapacitated
Person
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///
///
///
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23. Guardian ad Litem Compensation:
GUARDIAN AD LITEM REPORT - 5
2005 REVISED GUARDIANSHIP FORMS
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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__.
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Signature of Guardian ad Litem
Printed Name of Guardian ad Litem, WSBA#
Address
Telephone/Fax Number
City, State, Zip Code
Email Address
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GUARDIAN AD LITEM REPORT - 6
2005 REVISED GUARDIANSHIP FORMS
American LegalNet, Inc.
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