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Report Of Guardian Ad Litem Form. This is a Washington form and can be use in King Local County.
Tags: Report Of Guardian Ad Litem, 51, Washington Local County, King
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 ) Case No.: ) ) REPORT OF GUARDIAN AD LITEM ) ) (RTGAL) ) In the Guardianship of: ____________________, 10 11 An Alleged Incapacitated Person. 12 13 14 15 16 17 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. 18 19 1. Appointment: 20 Date of Appointment: 21 Date of Service of Copy of Petition on Guardian ad Litem: 22 Date Guardian ad Litem’s Statement of Qualifications was filed & served: 23 24 25 26 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 American LegalNet, Inc. www.USCourtForms.com 1 2. Precipitating Issues: 2 3. Personal Information Regarding Alleged Incapacitated Person: Date of Birth (optional): 3 4 5 6 7 8 9 10 11 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.) 12 13 14 Agreement or objection to appointment of a Guardian: Reaction to the proposed Guardian: Right to counsel: 15 Preferences regarding choice of counsel: 16 Right to a jury trial: 17 (Notes from the interview.) 18 19 20 21 22 23 24 25 26 GUARDIAN AD LITEM REPORT - 2 2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com 1 2 INVESTIGATION 3 6. Written Material Reviewed: I have reviewed the Medical/Psychological Report, ______, _________, and the pleadings and records on file. 4 7. Individuals Interviewed: During the course of my investigation, I interviewed the following person(s): 5 6 7 Name Date(s) of Contact Relationship to AIP 8 Investigation re the AIP’s ability to manage health, safety, nutrition and housing. Health: (Notes from interviews) 9 Housing: (Notes from interviews) 10 Nutrition: (Notes from interviews) 11 Safety: (Notes from interviews) 12 Investigation re: the AIP’s ability to manage finances: (Notes from interviews) 13 Investigation re: who is the appropriate guardian for the AIP: (Notes from interviews) 14 15 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: 16 Medical Diagnosis and Cause: 17 Degree of Incapacity: 18 9. Evaluation of Proposed Guardian(s): 19 Dates of Contact Between GAL and Proposed Guardian(s): 20 Identity and Contact Information of the Proposed Guardian(s): 21 Name: 22 23 Mailing Address: Telephone Number: Fax Number: 24 Email Address: 25 If Guardian is Certified, Provide Certification No.: 26 GUARDIAN AD LITEM REPORT - 3 2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 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 $ 16 Social Security Benefits Washington State Assistance Other Total Approx. Monthly Income 17 18. Recommendation Regarding Bond/Annual Reports: 18 [ ] The Court should set bond in the amount of $________________. 19 [ ] The Court should block or restrict access to the following assets: 20 _________________. 15 21 [ ] $ $ $____________ $ The Guardian should file reports [ 25 ] an annual report for the first year and then every third year /// 26 ] every third year [ 24 ] every other year [ 23 ] every year [ 22 /// GUARDIAN AD LITEM REPORT - 4 2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com 1 2 3 19. Recommendation Regarding Presence of AIP at Hearing: The presence of the Alleged Incapacitated Person [ ] should [ ] should not 4 be waived. ______________________________ is 5 [ ] able 6 [ ] unable 7 to attend the hearing. (If unable to attend, please explain the reason(s)): _______________________________________________________________________. 8 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.). 9 10 20. Other Recommendations: 11 12 21. Recommendation as to Guardian ad Litem’s Continuing Involvement in Future Proceedings: I recommend that the Guardian ad Litem 13 [ ] be 14 [ ] not be involved in future proceedings in this matter. 15 16 17 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 18 Relationship to Alleged Incapacitated Person 19 20 21 /// /// /// 22 23 24 25 26 23. Guardian ad Litem Compensation: GUARDIAN AD LITEM REPORT - 5 2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com 1 2 3 4 5 6 7 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__. 8 9 10 Signature of Guardian ad Litem Printed Name of Guardian ad Litem, WSBA# Address Telephone/Fax Number City, State, Zip Code Email Address 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 GUARDIAN AD LITEM REPORT - 6 2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com