Superior Court of Washington County of ______________________ In the Guardianship of: No. _______________________ Order Approving Budget, Disbursements, and Initial Personal Care Plan (ORAPRT) [ ] Clerk's Action Required ____________________________________, Incapacitated Person Clerk's Information Summary [X] Due Date for Next Report and Accounting: _____________________________________ [ ] Other (Date and Purpose): __________________________________________________ ____________________________________________________________________________ Based upon the petition of the Guardian of the Estate and the documents filed with the petition, the court makes the following findings of fact: I. Findings of Fact 1.1 Acts of Guardian All acts required of the Guardian to date have been performed. 1.2 Notice Notice has been properly provided to persons entitled to notice of this presentation. 1.3 Budget and Care Plan The proposed Budget and Care Plan of the Guardian are reasonable and appropriate to the needs of the Incapacitated Person and should be approved. Or Appr Budget/Disbrsmnt/Ini Pers Care Plan (ORAPRT) SPO GDN 05.0500 Page 1 of 4 (12/2015) American LegalNet, Inc. www.FormsWorkFlow.com II. Orders 2.1 Approval of Initial Personal Care Plan The Initial Personal Care Plan is approved. 2.2 Budget The Guardian is authorized to continue to receive the Incapacitated Person's income and to apply the income and other resources toward the Incapacitated Person's expenses: Room and Board Medical Rent/Mortgage Personal and Incidental Expenses Food and Household Expenses Utilities $ $ $ $ $ $ $ $ $ Guardian Fees Other Total Monthly Expenditures 2.3 Outstanding Obligations of the Estate The Guardian shall be authorized to arrange payment schedules with the creditors of the guardianship estate for delinquent and past due payments. 2.4 Medical and Dental Expenses The Guardian is authorized to incur and pay reasonable and necessary medical and dental expenses that the Guardian determines to be in the best interest of the Incapacitated Person. 2.5 Income Tax Payments/Accounting Fees The Guardian is authorized to make payments for income tax due as required, and to pay fees for accounting services required in connection with the preparation of income tax returns. 2.6 Miscellaneous Expenses The Guardian is authorized to pay all expenses incurred by way of fees of the Clerk of the Court, together with additional expenses incurred up to the amount of $50.00 per month in connection with this guardianship. 2.7 Accounting Due Date The Report and Accounting of the Guardian shall be filed and submitted to the Court for approval not later than ________________ (90 days after the first anniversary of the appointment of the Guardian). Or Appr Budget/Disbrsmnt/Ini Pers Care Plan (ORAPRT) SPO GDN 05.0500 Page 2 of 4 (12/2015) American LegalNet, Inc. www.FormsWorkFlow.com 2.8 2.9 Bond Bond is currently set in the amount of $_____________. The amount of the bond [ be changed [ ] shall be changed to $______________. ] shall not Fees The Guardian is allowed to advance a monthly fee up to $____________. This advance is approved for the next 12 months and 90 days thereafter, from the date of appointment of the Guardian to ___________________. Such fees are subject to review and approval by the Court at the next regular accounting. No presumption that these fees will be approved as reasonable is created by this authorization for advance. Amounts shall be advanced only for actual services provided, and costs actually incurred. Interim Guardian fees in the amount of $ ____________ for services rendered and administrative costs (DSHS cases only) of $ ___________ between _________________ and _______________ are reasonable and approved. [ ] DSHS cases. The above fees and costs are approved for payment as a monthly deduction from the incapacitated person's participation in the DSHS cost of care per WAC 388.79.030. Non-DSHS cases. The above fees are approved for payment from the guardianship estate assets. [ ] Guardian Total Fees Requested: $ Amount approved for advance: $ Additional fees Requested: $ Balance due (if approved): $ Administrative Costs ` $ (Medicaid cases only; hearing & notice to be given per WAC 388.79) Notice given to DSHS: Yes, (fees are over allowed amount) $ No, (fees do not exceed allowed amount) Attorney (court approval required) Accountant 2.11 Other $ $ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Dated _________________. _______________________________________ Judge/Court Commissioner ______________________________________ _________________________ ________________ Signature of Guardian/Attorney Print Name of Guardian/Attorney WSBA CPG# _________________________________________ Address _________________________________________ *Telephone/Fax Number _____________________________________________ City, State, Zip Code ______________________________________________ Email Address *If you do not want your personal phone number on this public form, you may list your telephone number on a separate form which may be available to parties and the court, as Or Appr Budget/Disbrsmnt/Ini Pers Care Plan (ORAPRT) SPO GDN 05.0500 Page 3 of 4 (12/2015) American LegalNet, Inc. www.FormsWorkFlow.com well as its staff and volunteers, but will not be made available to the public. Use Form WPF GDN 03.0100, Guardianship Confidential Information form (Telephone Numbers), for this purpose. Or Appr Budget/Disbrsmnt/Ini Pers Care Plan (ORAPRT) SPO GDN 05.0500 Page 4 of 4 (12/2015) American LegalNet, Inc. www.FormsWorkFlow.com