(Copy Receipt) SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE In the Guardianship of: _____________________________________ (Clerk's Date Stamp) CASE NO. __________________________ ORDER APPROVING GUARDIAN'S REPORT, ACCOUNTING AND BUDGET (Clerk's Action Required) Guardianship Summary (ORAPRT) An Incapacitated Person Due Dates Date Guardian Appointed Date Letters of Guardianship Expire: Due Date for Report and Accounting (GE): Guardian/Incapacitated Person [ ] Certified Professional Guardian [ ] Non-Professional Guardian ([ ] Training Required) [ ] Full [ ] Limited [ ] Estate [ ] Full [ ] Limited [ ] Person Relationship to Incapacitated Person ____________________________________ Incapacitated Person (include facility contact) Full Name Mailing Address City, State, Zip ORDER APPROVING GUARDIAN'S REPORT, ACCOUNTING AND BUDGET (ORAPRT) SPO GDN 02.0294 PAGE 1 OF 4 (12/2015) Guardian Individual LLC Incorporated American LegalNet, Inc. www.FormsWorkFlow.com *Telephone Number Facsimile Email Other Interested Parties Interested Party Full Name Mailing Address City, State, Zip *Telephone Number Facsimile Email Relation to Incapacitated Person Interested Party Having reviewed the Guardian's Report, Accounting, and Budget the Court now orders: 1. The Guardian's Report, Accounting, and Budget is approved; 2. The Guardian shall provide the next Report and Accounting for the 12, 24 or 36 month period from ________________________ (the ending date of the last reporting period); and the Report, Accounting, and Proposed Budget shall be presented to the Court for review and approval; 3. The Guardian's fees of $__________________, attorney fees of $___________________ and administrative costs (DSHS cases only) of $___________________ payable during the period covered in this report are hereby approved. 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 $________ $________ ORDER APPROVING GUARDIAN'S REPORT, ACCOUNTING AND BUDGET (ORAPRT) SPO GDN 02.0294 PAGE 2 OF 4 (12/2015) American LegalNet, Inc. www.FormsWorkFlow.com The advance of Guardian's fees for the upcoming reporting period, in the amount up to $_______________ per month, appear to be reasonable and necessary but are subject to court approval at the next hearing. Above fees are approved for payment from the estate assets (after basic needs and personal allowance) OR guardianship as a monthly deduction from the incapacitated person's participation in the DSHS cost of care per WAC 388.79. The monthly deduction from the participation in cost of care is authorized for the next reporting period and 120 days thereafter. 4. Bond remains the same or is changed to $_____________; and 5. The Clerk of the Court shall reissue letters of guardianship of the person and estate to __________________ (name of guardian) expiring on ______________________. All prior letters of guardianship have expired. 6. The guardian shall cooperate with the Superior Court Guardianship Monitoring Program by providing to the program's designee access to the incapacitated person for in-home visits and access to any information, available to the guardian, including medical records, relating to the incapacitated person. 7. The Court finds several previous Non Compliance Notices and/or Orders to Show Cause have been issued. In the event the next report is not filed timely and a Non Compliance and/or Order to Show Cause is issued a sanction of $____________________ will be imposed. 8. Other: ___________________________________________________________________. DATED AND SIGNED IN OPEN COURT THIS ______ DAY OF _____________ , 20______. Judge/Court Commissioner Signature of Guardian/Attorney Printed Name of Guardian/Attorney, WSBA/CPG# PAGE 3 OF 4 (12/2015) ORDER APPROVING GUARDIAN'S REPORT, ACCOUNTING AND BUDGET (ORAPRT) SPO GDN 02.0294 American LegalNet, Inc. www.FormsWorkFlow.com Address *Telephone/Fax Number City, State, Zip Code 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 #S2Sealed Confidential Information and file in the confidential file. ORDER APPROVING GUARDIAN'S REPORT, ACCOUNTING AND BUDGET (ORAPRT) SPO GDN 02.0294 PAGE 4 OF 4 (12/2015) American LegalNet, Inc. www.FormsWorkFlow.com