(Copy Receipt) (Clerk’s Date Stamp) SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE In the Guardianship of: CASE NO. _________________________ _____________________________________ NOTICE OF CHANGE IN CIRCUMSTANCES (NT) The following circumstances have changed with regard to the Incapacitated Person. 1. Financial. [Examples of changes in circumstances include: a material increase or decrease in income or assets, including eligibility for state, or federal benefits or entitlements.] _______ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2. Physical. [Examples of changes in condition include: a material change in health, such as hospitalization, illness, increase or decrease in mental abilities.] ________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ #34-NOTICE OF CHANGE IN CIRCUMSTANCES PAGE 1 OF 2 Revised 3/07 American LegalNet, Inc. www.FormsWorkflow.com I certify (or declare) under penalty of perjury under the laws of the State of Washington that to the best of my knowledge the statements above are true and correct. DATED AND SIGNED IN OPEN COURT THIS _____ DAY OF ________________, 20___. Signature of Guardian/Attorney Printed Name of Guardian/Attorney, WSBA/CPG# Address City, State, Zip Code *Telephone/Fax Number Email Address *Under GR 22 (b) (6), parties’ personal telephone number(s) are confidential information. If you do not want your personal phone number(s) on this public form, complete form #S2-Sealed Confidential Information and file in the confidential file. #34-NOTICE OF CHANGE IN CIRCUMSTANCES PAGE 2 OF 2 Revised 3/07 American LegalNet, Inc. www.FormsWorkflow.com