(Copy Receipt) (Clerk’s Date Stamp) SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE In the Guardianship of: CASE NO. __________________________ __________________________________ PETITION FOR ORDER APPROVING GUARDIAN’S ACTIVITIES AND FINAL REPORT PETITION AND FINAL REPORT The Guardian petitions the Court for approval of this Final Report. 1. Guardianship History. The undersigned was appointed the Person and/or Full Full Limited Guardian of Limited Guardian of the Estate on ________________. The Guardian’s most recent report was approved on _______________, and it included all activities, income and disbursements through the date of _________________. 2. Residence of Incapacitated Person: Throughout this report period, the Incapacitated Person resided at ____________________________________________________________________ [facility name & address], in the city or county of _____________________________. 3. Circumstances for Final Order. A. If Final Order Due to Death of Incapacitated Person: The Incapacitated Person died on _______________. The Incapacitated Person died with OR without a Will. (If there is a #61A-PETITION FOR ORDER APPROVING GUARDIAN’S ACTIVITIES & FINAL REPORT PAGE 1 OF 4 Revised 3/07 American LegalNet, Inc. www.FormsWorkflow.com will, attach a copy.) The Guardian requests authority to transfer the remaining Guardianship estate assets to the duly appointed or confirmed Personal Representative of the Estate, upon receipt of a Notice of Appointment and Pendency of Probate or properly executed Affidavit of Successor. B. If Final Order Due to Determination of Capacity: On ___________________, (date) the Court determined that the incapacity had terminated and that there was now capacity to manage the personal care and administration of assets. I was directed to transfer all Guardianship assets to the (formerly) Incapacitated Person. C. If Final Order Due to Removal of Guardian: On ___________________, (date) the Court removed the Guardian herein. The Guardian requested authority to transfer the assets to the duly appointed Successor Guardian upon the issuance of letters of Guardianship to said Successor. 4. Care Plan. A report setting forth the medical, mental, and social information for the Incapacitated Person and describing the Guardian’s activities from the conclusion of the last reporting period date: ________________ until the restoration of capacity OR death of above-named Incapacitated Person is attached hereto. 5. Current Inventory. A listing of all of the assets of the Incapacitated Person’s estate as of the date of the last reporting period: __________________ and of this date and their values on each date is attached hereto. 6. Income and Disbursement. A summary listing by categories of all income and disbursements from the conclusion of the last reporting period to this date is attached hereto. 7. Liabilities. The Guardian requests approval to pay the following outstanding liabilities from the Guardianship estate. Guardian’s Fees and Costs Attorney’s Fees and Costs Other: Other: Other: Total Payments to be Authorized: $ $ $ $ $ $ #61A-PETITION FOR ORDER APPROVING GUARDIAN’S ACTIVITIES & FINAL REPORT PAGE 2 OF 4 Revised 3/07 American LegalNet, Inc. www.FormsWorkflow.com 8. Bond, Blocked Accounts and Other Court-Ordered Protection. At the date of termination of the Guardianship, there was $_____________ in unblocked accounts and $_____________ in blocked financial accounts. The Guardianship bond issued by __________________________ identified by bond number ________________, in the amount of $________________ (enter $0, if there was no bond in effect) should be exonerated upon the filing of a receipt by the Personal Representative or Successor Guardian of Incapacitated Person. 9. Final Tax Return. There was income for which a tax return is OR is not required. The Guardian recommends that the final tax return and tax obligations be handled as follows: ____________________________________________________________________________. WHEREFORE, the Guardian requests an order: 1. Approving the Guardian’s Final Report and Accounting and the actions of the Guardian; 2. Closing the Guardianship case, discharging the Guardian and exonerating the bond of the Guardian, upon the filing of a request for receipt of assets by the Personal Representative, Successor Guardian or previously Incapacitated Person; 3. Authorizing the Guardian to transfer the remaining assets in the Guardianship estate to the duly appointed or confirmed Personal Representative, Successor Guardian or previously Incapacitated Person, upon receipt of the notification of appointment and pendency of probate or properly executed affidavit of successor. 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. SIGNED AT _____________, WASHINGTON 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 #61A-PETITION FOR ORDER APPROVING GUARDIAN’S ACTIVITIES & FINAL REPORT PAGE 3 OF 4 Revised 3/07 American LegalNet, Inc. www.FormsWorkflow.com *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. #61A-PETITION FOR ORDER APPROVING GUARDIAN’S ACTIVITIES & FINAL REPORT PAGE 4 OF 4 Revised 3/07 American LegalNet, Inc. www.FormsWorkflow.com