Free QUICK REFERENCE AND INFORMATION FOR CERTIFICATION GUARDIANS - Kansas

BASIC INSTRUCTIONS FOR GUARDIANS AND CONSERVATORS

January 1, 2009

Kansas Judicial Council

Preface

These basic instructions for guardians and conservators were prepared by the Guardianship and Conservatorship Advisory Committee of the Kansas Judicial Council and were approved by the Council in December 2008. The instructions constitute the basic instructional program concerning the duties and responsibilities of a guardian and conservator required by K.S.A. 2009 Supp. 59-3069(j). After reading these instructions, a proposed guardian or conservator should sign the affidavit of completion at the end of this booklet and file it with the court as evidence of completion of the basic instructional program.

Table of Contents

Definitions .................................................................................................................. 1 Guardian's Powers and Duties .................................................................................. 1 Conservator's Powers and Duties ............................................................................. 3 Responsibilities to the Court Required Training ........................................................................................... 5 Oath ................................................................................................................ 5 Bond ............................................................................................................... 5 Letters ............................................................................................................. 5 Guardianship and/or Conservatorship Plans .................................................. 5 Inventory and Valuation .................................................................................. 6 Annual Accounting .......................................................................................... 6 Guardian's Annual Report on the Ward's Condition ....................................... 6 Special Reports and Accountings ................................................................... 6 Reimbursement for Time and Expenses ......................................................... 7 Conflicts of Interest .................................................................................................... 7 Additional Resources ................................................................................................. 7 Sample Forms Inventory and Valuation - Instructions for Completing .................................... 8 Sample Inventory and Valuation ..................................................................... 9 Annual Accounting - Instructions for Completing .......................................... 11 Sample Annual Accounting ........................................................................... 13 Sample Report on Condition of Guardian's Ward ......................................... 17 Affidavit of Completion of Basic Instructional Program ................................. last page

BASIC INSTRUCTIONS FOR GUARDIANS AND CONSERVATORS

Definitions of Words You Need to Know: Guardian - A guardian is a person appointed by a court to act on behalf of a minor or impaired person, who is called a "ward." A guardian manages a ward's personal health, safety, and welfare. Ward - A ward is a person for whom a guardian has been appointed. A ward may be either a minor or an adult person with an impairment. Conservator - A conservator is a person appointed by a court to act on behalf of a minor or impaired person, who is called a "conservatee." A conservator manages a conservatee's property or "estate," such as money, personal and real property. Conservatee - A conservatee is a person for whom a conservator has been appointed. A conservatee may be either a minor or an adult person with an impairment. Accounting - A detailed written summary of all financial actions done by the conservator on behalf of the conservatee. Bond - A bond is similar to an insurance policy and is usually purchased from an insurance company. It is intended to protect the conservatee's property should the conservator mismanage the person's estate. NOTE: Sometimes, a person is appointed as both a guardian and conservator. In that case, the person they are helping may be called either a ward or conservatee, or both.

What Are a Guardian's Powers and Duties? A guardianship is a legal proceeding filed to protect an impaired person, who is called a "ward." A guardian manages a ward's personal health, safety, and welfare. If the court appoints you as guardian your job is separate from the duties of a conservator, though the court may appoint the same person to serve in both roles. As guardian you are always subject to the control and direction of the court. After a hearing to determine whether a guardianship is necessary, a court order will be issued. Your attorney should provide you with a copy of that court order. State law and the court define a guardian's power and set the rules to be followed when caring for the ward. At all times, a guardian is under the court's direction and control. A guardian must always act in the ward's best interest and use reasonable care and attention. EACH YEAR THE GUARDIAN MUST FILE A REPORT WITH THE

1

COURT TELLING THE COURT ABOUT THE GUARDIAN'S ACTIONS AND THE WARD'S CONDITION. As a guardian, your job is to get to know the ward and the ward's family, friends, and care givers. You should use your authority only as needed and allow the ward to take part in decisions. You should consider the ward's personal desires and values when making decisions on the ward's behalf. You should encourage the ward to make decisions, develop skills for daily living, and do as much as the ward can on his or her own. The law does NOT require you as guardian to use your own personal money or other assets for support of the ward solely because you have been appointed as guardian. However, if you are the parent or spouse of the ward, you may have an independent duty to support the ward. You are not liable to other persons for the acts of the ward solely because you have been appointed as guardian. This means you are not responsible to any one else for something that the ward has done simply because you are the guardian. You should protect the ward's personal, civil, and human rights. The law requires that you MUST ALWAYS act in the best interest of the ward and exercise reasonable care, diligence, and good sense. As a guardian, you MAY generally take any of the following actions on behalf of the ward without getting additional court approval: 1. 2. 3. 4. 5. 6. 7. Take charge of the ward and provide for the ward's care, treatment, housing, education, support, and maintenance; Give or withhold consents for the ward except those listed below; Assure the ward is living in the least restrictive setting that meets his or her needs; Assure the ward receives medical and nonmedical care; Protect the health, safety, and welfare of the ward; Make necessary arrangements for the ward's funeral, burial or cremation; and Revoke a power of attorney.

As a guardian, you may NOT take any of the following actions UNLESS the supervising court issues a written order approving the action(s): 1. 2. 3. 4. 5. Consent to adoption of the ward; Consent to any psychosurgery, organ or limb removal except in a life threatening emergency or to prevent lasting impairment to the ward's physical body; Consent to sterilization of the ward; Consent to experimental procedures; Consent to withholding or withdrawal of life-saving medical care unless the ward previously made a written advance directive (living will, durable power of attorney for health care decisions, or similar document) that meets legal requirements; Have any control over the ward's property, unless the Letters of Guardianship 2

6.

7. 8. 9.

authorize you to do so AND the value of the ward's property is less than $10,000; Place the ward in a psychiatric treatment facility; Pay guardian fees or reimburse expenses; or Dispose of property after the ward's death. As a guardian, you may NEVER take any of the following actions:

1. 2.

Prohibit the marriage or divorce of the ward; or Consent to termination of the ward's parental rights.

What Are a Conservator's Powers and Duties? THESE DUTIES APPLY TO BOTH VOLUNTARY AND INVOLUNTARY CONSERVATORSHIPS A conservatorship is a lawsuit filed to protect the property of an impaired person, who is called a "conservatee." After a hearing to determine whether a conservatorship is necessary, a court order will be issued. Your attorney should provide you with a copy of that court order. Before the court will issue you Letters of Conservatorship, you must be bonded unless the court waives the bond. If the court appoints you as conservator, your responsibilities are separate from the duties of a guardian and your job is to manage the conservatee's property. The conservatee's property is called his or her "estate." As conservator, you are always subject to court control and direction. State law and the court define your power, as conservator, and set the rules you must follow when managing the conservatee's property. As conservator, you must always act in the best interest of the conservatee. Your first duty, as conservator, is to open a bank account under the conservatee's social security number, titled in your name "as conservator" for the conservatee. You will then need to file an inventory (a detailed list) of all assets in the conservatee's estate within 30 days of issuance of the Letters of Conservatorship. NEVER combine the conservatee's assets with those of another person, including your own. THE CONSERVATOR MUST FILE AN ACCOUNTING WITH THE COURT EACH YEAR. You must know the conservatee's needs and support and involve the conservatee in decision-making regarding his or her property. You should consider the conservatee's stated desires and personal values when making decisions for him or her. You must try to avoid conflicts of interest and protect the conservatee's personal, civil, and human rights. The law does NOT require you as conservator to use your own personal money or other assets for support of the conservatee solely because you have been appointed as conservatee. However, if you are the parent or spouse of the conservatee, you may have an independent duty to support the conservatee. You are not liable to other 3

persons for the acts of the conservatee solely because you have been appointed as conservator. This means you are not responsible to anyone else for something that the conservatee has done simply because you are the conservator. As a conservator, you MAY generally take any of the following actions on behalf of the conservatee without getting additional court approval: 1. Pay reasonable charges for the support, care, clothing, housing, and education of the conservatee in a reasonable manner, unless the conservatee's parent or spouse is required by law to pay those charges; Pay all lawful debts of the conservatee; Control and manage all the conservatee's property and collect debts and assert claims in favor of the conservatee (for example, if the conservatee is owed money); Insure property against theft or other loss in a reasonable amount; or Pay the premium for your conservator's bond.

2. 3.

4. 5.

The following decisions ALWAYS require WRITTEN court approval. As conservator, you may NOT take any of the following actions unless the supervising court issues a written order approving the action(s): 1. 2. 3. 4. 5. 6. 7. 8. 9. Settle any claim of the conservatee for less than full value; Sell or transfer the property of any ongoing businesses; Sell, convey, lease, or mortgage the conservatee's homestead or other real estate; Lease or convey possession in any real estate for more than 3 years; Sell, convey, or mortgage any oil, gas, or other mineral interests; Sell, convey, lease, or mortgage any inchoate interests in real estate; Extend an existing mortgage for more than 5 years, which includes both mortgages where the conservatee is the borrower or the lender; Make a gift on behalf of the conservatee; or Pay the conservator or the conservator's attorney a fee.

The following decisions MAY require court approval. As conservator, you should get court approval before taking any of the following actions: 1. 2. 3. Sell the conservatee's personal property as necessary; Manage any ongoing business; Invest funds in a conservative and reasonable manner, including purchasing an insurance policy or annuity, reserving to the conservatee the right to change the beneficiary on termination of the conservatorship; Prosecute and defend all actions in the name of the conservatee; or Dispose of property after the death of the conservatee.

4. 5.

4

What Are a Guardian and Conservator's Responsibilities to the Court? Required Training Before you are appointed as guardian and conservator, you must complete a basic training program about the duties and responsibilities of a guardian and conservator. Reading this booklet meets that requirement. At the end of this booklet, you will find an affidavit of completion of the basic training program (a form stating you have read the booklet). When you finish reading this booklet, you should sign the affidavit and file it with the court to prove that you have completed the program. You should also keep this booklet for future reference. Oath When you are appointed as guardian and conservator, the court will require that you file an oath or affirmation stating that you will faithfully, impartially and to the best of your ability fulfill all duties assigned by the court. The oath must be in writing and signed before a notary or the judge. Bond When you are appointed as conservator (and sometimes as guardian), you must be bonded unless the court waives the bond. A bond is intended to protect the conservatee's property should the conservator mismanage the person's estate. The court will determine the amount of the bond and whether sureties are necessary. Bonds are usually purchased from an insurance company with the assistance of an insurance agent. To keep the bond in effect, you must pay a yearly premium (fee). You will be released from the bond only after the court has approved your actions and final accounting and has ended the conservatorship. Letters After you have filed your oath and affidavit of completion of the basic training program, the court will issue Letters of Guardianship and Conservatorship. This document gives you the authority to carry out your legal duties. You should ask for a certified (legal) copy of the original document, which is on file with the court. You should keep the certified copy in a safe place and provide copies of the Letters of Guardianship and Conservatorship to anyone you deal with who provides services to the ward/conservatee. Guardianship and/or Conservatorship Plans In some cases, the court may require, or your attorney may suggest, that you file a guardianship or conservatorship plan. A guardianship plan might include provisions about where a ward will live and what kinds of decisions the ward will be allowed to make on his or her own. A conservatorship plan might include provisions about how much money a conservatee will be allowed to control and how the conservator plans to 5

protect the eligibility of the conservatee for public benefits. Guardianship and conservatorship plans are most useful in situations where the ward or conservatee is capable of making some decisions independently. Inventory and Valuation A conservator (and sometimes a guardian) is required to file with the court an inventory and valuation (statement of worth) of the property and assets of the conservatee's estate, including any sources of regular income. This must be done within 30 days of issuance of the Letters of Conservatorship. The inventory and valuation describes the conservatee's estate at the time the conservatorship begins. You must list and describe each property and asset separately and give its full and fair value. You may need to obtain an independent appraisal of some assets. A sample of the inventory and valuation is included at the end of this booklet. Annual Accounting A conservator (and sometimes a guardian) is required to file a detailed accounting every year of both income and payments made on behalf of the conservatee. The reporting period usually starts when the conservator is appointed and covers a 12-month period of time, unless the judge orders a different reporting time period. A sample of the annual accounting is included at the end of this booklet. Guardian's Annual Report on the Ward's Condition Because the court needs to know where the ward is living and how the ward is doing, a guardian must file a report on the ward's condition every year. This report is required even if there is no change in the ward's condition. The reporting period usually starts when the guardian is appointed and covers a 12-month period of time, unless the judge orders a different reporting time period. A sample of the annual report is included at the end of this booklet. Special Reports and Accountings A guardian and conservator must file a special report or accounting with the court if any of the following occurs: 1) a change of address of the guardian or conservator; 2) a change of residence or placement of the ward or conservatee; 3) a significant change in the health or impairment of the ward or conservatee; 4) in the case of a guardianship, if the ward acquires any real property, or if the ward receives or accumulates other property or income which causes the total value of the ward's estate to equal or exceed $10,000; or 5) the death of the ward or conservatee. If the ward/conservatee dies, you will need to complete a final report on the ward/conservatee's condition as well as a final accounting of the ward/conservatee's 6

assets and have that accounting approved by the court so that the court can close the case. Reimbursement for Time and Expenses The court must approve in advance any reimbursement to the guardian and conservator for expenses and time spent on official duties. If you want to be paid back for your time and expenses, you must keep a detailed timesheet of time spent and a detailed record of expenses incurred. Many guardians and conservators do not claim such expenses, especially if the ward/conservatee is a family member, and perform their duties out of love and affection. If you want to receive reimbursement, you should talk to your attorney and bring this up preferably at the first court hearing.

What are Conflicts of Interest? A conflict of interest happens when your personal or financial interests as guardian and conservator go against those of the ward/conservatee or where your actions appear to be self-serving (for your own benefit). For example, it would be a conflict of interest for a guardian and conservator to get a loan from or buy property belonging to the conservatee's estate. It could also be a conflict of interest for a guardian and conservator to work in the same facility where the ward lives. Whenever you think you might have a conflict of interest, even if you are not sure, report it to the court. Just because you may have a conflict of interest does not mean you cannot serve as guardian and conservator, as long as you keep the court informed. Additional resources: If you have questions about any of your duties as a guardian and conservator, ask your attorney. Additional resources, including blank forms for inventories, accountings, and guardian's reports, can be found on the Kansas Judicial Council's webpage at: www.kansasjudicialcouncil.org

7

CONSERVATOR INVENTORY AND VALUATION Instructions for Completing Definition A detailed list or inventory of the conservatee's estate (property and financial resources) at the time of appointment of a conservator. Filing Procedures The inventory is filed with the court within 30 days of the appointment date. Preparing Documents for the Court This document is a permanent legal record. The information should be typed or written legibly. Use black or dark blue ink when reports are handwritten. Supplementary Inventory and Valuation may be filed to change or add information. ASSESSING VALUES Real Estate Provide a legal description and the appraised value of the property. The property description is available from the local Register of Deeds office. The assessed value is available from the County Treasurer office. Stocks and Bonds (Corporation Stocks) List all stocks and bonds and the values. Mortgages, Notes and Cash List any mortgages, notes or cash owned by the conservatee. Include checking and/or savings accounts, cash on hand, and funeral/burial trust in this section. Insurance Provide cash value of all insurance policies.

Jointly Owned Property Verify jointly owned property including the legal description and name of owner(s). Miscellaneous Property Furniture, household goods and wearing apparel - List individually valuable items such as antiques, jewelry, coins, electronics, etc. For assistance for appraisals on items of value, contact a credible antique dealer or auctioneer. Household goods and wearing apparel may be listed as a combined value. Sources of Regular Income List any sources of regular income such as social security, disability benefits, pension or retirement income, and interest. Add pages as needed to provide complete documentation.

8

IN THE ______ JUDICIAL DISTRICT DISTRICT COURT OF APACHE COUNTY, KANSAS
In the Matter of the (Guardianship) (Conservatorship) Samuel G. Crown Proceeding Pursuant to K.S.A. Chapter 59 Case No. 97 GC 031

INVENTORY AND VALUATION REAL ESTATE
Item No

Description 39 Solar Haven Rd, Lot 59, Solar Haven Addition, Sanesville, KS 66666 Joint Tenancy with Mrs. Betty Crown Total Real Estate . . . . . STOCKS AND BONDS (Corporate Stock)

Valuation $ 45,489

1.

$45,489

Item No

Description

Unit Value

Valuation $ 000.00

1. BONDS
Item No

Serial Number

Date of Purchase

Unit Value

Valuation $ 000.00

1. MORTGAGES, NOTES AND CASH
Item No

Description Checking Account, Savers Union Bank, Sanesville, KS Savings Account, Savers Union Bank, Sanesville, KS Total Mortgages, Notes and Cash

Valuation $1,178.00 $ 8,978.44 $ 10,156.44

1. 2.

INSURANCE
Item No

Description Red Shield Life Insurance, Sanesville, KS (Cash Value) Total Insurance

Valuation $ 10,000.00 $ 10,000.00

1.

9

JOINTLY OWNED PROPERTY
Item No

Description

Valuation $

1. Total Jointly Owned Property MISCELLANEOUS PROPERTY
Item No

$ 000.00

Description Funeral and Burial Trust, Timberline Mortuary, Sanesville, KS Household Furnishings Lawn Mower and Tools Wearing Apparel Antique Gun Collection Total Miscellaneous Property RECAPITULATION

Valuation $ 4,250.00 $ 4,500.00 $ $ 300.00 500.00

1. 2. 3. 4. 5.

$ 1,500.00 $ 11,050.00

Valuation Real Estate Stocks and Bonds
Mortgages, Notes & Cash

...................................... ...................................... ...................................... ...................................... ...................................... ...................................... TOTAL ESTATE

$ 45,498.00 -0-010,000.00 -011,050.00 $ 66,548.00

Insurance Jointly Owned Property Miscellaneous Property

SOURCES OF REGULAR INCOME Social Security disability insurance KPERS retirement Veteran's benefit Interest from bank accounts $415/mo $685/mo $380/mo amount varies

I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct executed on June 27, 2008.

Conservator 10

ANNUAL CONSERVATOR ACCOUNTING Instructions for Completing

This is a report of all income (receipts) and disbursements (expenses) of the estate transacted during the accounting period. It also updates the inventory and valuation. The accounting is submitted to the court once a year either on the anniversary date of the appointment of the conservator, or, on a calendar year basis. This varies by county. File the accounting within 30 days of the end of the accounting period. Record Keeping Keep the following financial information to prepare an accurate accounting: Bank Statements, check book register, copies of cancelled checks Receipts of items purchased Financial reports from trust accounts

COMPLETING THE ACCOUNTING 1. The accounting is a permanent legal record. The form should be typed OR written legibly. Use black or dark blue ink when reports are handwritten 2. Work from bank statements to prepare the accounting using the check register for support information. 3. Attachments - Financial Statements from a Provider If the person lives in a facility, or the provider is the payee for the conservatee's benefits, some courts will accept an attachment of the monthly or quarterly financial statements from the provider. Check the math accuracy before attaching to the accounting. Computer Generated Financial Spread Sheets Some courts will accept an accounting generated by a computer program. Courts may have a format preference for how information is presented. Generally, there are two acceptable formats: Format 1 - Spread Sheet Set up looks like the check book register and includes a running balance of "cash on hand." Advantage: The accounting may be easily prepared from the bank statements. Format 2 - Spread Sheet Columns totaling income, disbursements and a final balance of cash on hand. I. STATEMENT OF RECEIPTS (INCOME) AND DISBURSEMENTS (EXPENSES) 11

Balance Carried Forward If an accounting was filed for the previous year - The "balance carried forward" should be the same amount as the "balance on hand" from the previous year accounting. If No accounting was filed for the previous year - The balance carried forward is the cash balance on the initial Inventory and Valuation. Receipts (Income) Itemize receipts from all sources received in the accounting period. Add additional pages if needed. Fill in all the information required on the form. Income for the same amount may be documented in lump sums. Refer to Sample Accounting. Disbursements (Expenditures) Itemize all money spent during the accounting period. Add pages if needed. Fill in all the information required on the form. Expenses for the same amount (i.e. cable, or phone) may be documented in lump sums. Refer to Sample Accounting. Summary List the total receipts and the total disbursements. The cash balance is the difference between the total receipts and total expenditures. II. INVENTORY Real Estate - List any real estate including the appraised value. Personal Property 1. Financial Institution Accounts (a) Checking - the check book balance for the end of accounting reporting period (b) Savings - the account balance (c) Certificates of Deposit - list any certificates owned (d) Other - note other accounts not listed above (i.e. resident trust account) 2. Stocks and Bonds - List any stocks and bonds owned by conservatee. 3. Other Personal Property - Include: Burial/Funeral trust, value of clothing, furniture, household goods. Document new purchases such as a TV, bicycle or furniture. Total the personal property. 4. Add the totals from Total Personal Property and Total Real Estate and put the amount on the Total Real Estate and Total Personal Property line.

12

IN THE ______ JUDICIAL DISTRICT DISTRICT COURT OF APACHE COUNTY, KANSAS In the Matter of the (Guardianship) (Conservatorship) Samuel G. Crown Proceeding Pursuant to K.S.A. Chapter 59 V ANNUAL In the Conservatorship of Samuel G. Crown Comes now, Marjorie Crestone Name Sanesville, KS 66666 City & Zip Code _ FINAL ACCOUNTING July 01, 2007 to June 30, 2008 3299 Smithville Road, Apartment #4 Address (785) 999-7100 Telephone Number

Case No. 97 GC 031

(guardian) (conservator) in the above entitled estate and submits the following (annual) (final) accounting in the conservatorship of Samuel G. Crown Name 39 Solar Haven Rd, Sanesville, KS 66666 Address, City & Zip Code

1942 for the period from July 01, 2007 to June 30, 2008 Year of Birth

SAMPLE
I. Statement of Receipts and Disbursements RECEIPTS (INCOME) RECEIVED FROM Balance Carried Forward EXPLANATION Checking Account $ 415 X 6 mos $ 425 X 6 mos $ 380 x 12 mos $ 685 x 12 mos Yrly Checking Account Interest Social Security Admin Social Security Admin Veterans Affairs KPERS Retirement Savers Union Bank US Treasury Crown Savings Account Savers Union Bank

DATE

AMOUNT $1,050.00 2,490.00 2,550.00 4,560.00 8,220.00 16.98 75.00 1,000.00 2,000.00

July - Dec 2007 Jan - June 2008 July - June 2008 July - June 2008 July - June 2008 July - June 2008 May 28, 2008 June 15, 2008

IRS Tax Refund - Earned Income Credit Transfer of Funds Cashed Certificate of Deposit

13

Total Receipts (Including balance carried forward)

$ 22,491.98

DISBURSEMENTS (EXPENSES) from Checking Account DATE
07/07-06/08 07/07-06/08 07/07-06/08 07/07-06/08 07/07-06/08 07/07-06/08 07/07-06/08 07/07-06/08 07/07-06/08 07/07-06/08 07/07-06/08 07/14/07 07/07-06/08 07/14/07 08/19/07 09/20/07 10/10/07 11/28/07 12/12/07 02/24/08 04/28/08 05/24/08 06/17/08 06/18/08 06/18/08 06/22/08 06/22/08 06/22/08 Check #

PAID TO
Savers Union Bank W estar Energy City W ater Dept KS Gas Service Ripple City Cable Birch Telephone Sanesville Life Line BCBS Insurance Pelley Pharm acy Tuppence Foods Sam uel Crown K-Mart

PURPOSE
Monthly Mortgage - Incls Insurance ($568 x 12 m os) Electrical Utility (Average Paym ent Plan $55 x 12) W ater and Sewage ($35 x 12 m os) Gas Utility (Equal Paym ents Plan $70 x 12) Cable Bill ($38.50 x 12 m os) Phone ($41.89 per m onth X 12 m os) Medical Alert ($ 19.99 x 12 m os) Supplem ental Insurance ($ 97.45 x 12 m os) Prescription Co-pay Groceries $65 x 52 wks (Per Conservator Plan) Spending Money ($100/m o x 12) (Conservator Plan) Socks, personal hygiene produces, video Haircuts ($10 x 12 m os)

AMOUNT
$6, 816.00 660.00 420.00 840.00 462.00 502.68 239.88 1,169.40 168.00 3,380.00 1,200.00 130.00 120.00 300.00 120.00 124.00 150.00 220.00 1,200.00 456.78 687.92 725.67 85.00 50.00 298.00 220.00 36.25 143.30

#2498

SAMPLE
Barber of Saville Seniors Travel Sanesville Library W alm art Sanesville Bowl Sears Orville Furniture W alm art Penney's County Treasurer W alm art Sears & Applebees Dr. Long Tooth Eye Magic Savers Union Bank Sanesville Tim es Public Transportation (12 books x $25 x 12 m os) Audio Reader Rental ($10 x 12 m os) Jeans, shirts, under wear Senior Bowling; Senior Olym pics - Yrly Fee W inter Jacket; Christm as gifts Lift Chair for Sam uel Crown Clothing; personal care item s; TV Towels, bath set, shower curtain; (Dresser $400) Yearly Property Taxes Hygiene item s; household cleaners Birthday Gift and Dinner for Sam uel Crown Dentist - cleaning and two fillings New Glasses Ordered Checks Newspaper Subscription ($11.95 x 12 m os)

#2501 #2543 #2559 #2561 #2584 #2598 #2677 #2792 #2812 #2822 #2823 #2824 #2825 #2826 #2827

14

06/24/08

#2828

US Post Office

Stam ps for paying bills ($7.80 x 4 books) TOTAL

31.20 $ 20,956.08

Savings Account Transactions DATE
07/01/07

PAID TO
Beginning Balance

PURPOSE

AMOUNT
$8,245.95

08/30/07

Sam uel Crown

1/4ly Interest

(+ 3.45)

12/31/07

Sam uel Crown

1/4ly Interest

(+3.79)

03/31/08

Sam uel Crown

1/4ly Interest

(+3.57)

05/28/08

06/30/08

SAMPLE
Sam uel Crown Transfer to Checking Account Sam uel Crown 1/4ly Interest

(-1,000.00)

(+3.02)

15

$7,259.78

SUMMARY Total Receipts .................................................................................................................... Total Disbursements ......................................................................................................... Cash Balance on Hand ..................................................................................................... $ 22,491.98 $ 20,956.08 $ 1,525.90

II. INVENTORY as of June 30, 2008 Your conservator accounts for the fair market value of the following assets:

REAL ESTATE Value

Fair Market

1. 39 Solar Haven Rd, Lot 59, Solar Haven Addition, Sanesville, KS 66666 Joint Tenancy with Mrs. Betty Crown, spouse.

SAMPLE
PERSONAL PROPERTY

$ 45,489.00 $

Total Real Estate $ 45,489.00

1. Financial Institution Accounts Description (a) Checking Account - Savers Union Bank, Sanesville, KS (b) Savings - Savers Union Bank, Sanesville, KS (c) Certificates of Deposit (one CD - valued at $ 4,329) (d) Burial/Funeral Trust (Timberline Mortuary, Sanesville, KS as of 06/30/08) Amount $ 1,525.90 $ 7,259.78

$ 4,329.71 $ 4,600.00

2. Stocks & Bonds

$

-0-

3. Other Personal Property Household goods, furniture, wearing apparel Television $250; Dresser $400; Lift Chair $1,200 $ 5,455.00 $ 1,800.00

16

Total Personal Property Total real Estate and Personal Property

$

7,255.00

$ 70,459.39

I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct executed on _________________, 20 ____.
_____________________________________

Conservator

SAMPLE

17

IN THE ______ JUDICIAL DISTRICT DISTRICT COURT OF APACHE COUNTY, KANSAS In the Matter of the (Guardianship) (Conservatorship) of ) ) ) Samuel G. Crown ) ) Proceeding Pursuant to K.S.A. Chapter 59 X ANNUAL

Case No. 97 GC 031

_ FINAL REPORT ON THE CONDITION OF THE GUARDIAN'S WARD From July 01, 2007 to June 30, 2008

Comes now, Marjorie Crestone
Name

3299 Smithville Road, Apartment #4
Address

Sanesville, KS 66666
City & Zip Code

(785) 999-71000
Telephone Number

guardian in the above entitled estate and submits the following (annual) (final) report on the condition of: Samuel G. Crown
Name

SAMPLE
1942
Year of Birth

1. The ward resided at the following places during the reporting period: 39 Solar Haven Rd, Sanesville, KS 66666. Own home. 22 years. (address) Type of Residence (Length of stay) 2. State the approximate number of times the guardian has contact with the ward, the nature of such contacts, and the date the ward was last seen by the guardian: Guardian visits ward in his own home approximately two to three times per month. Guardian checks on the ward's health status, sufficient groceries, household and personal care items, and the home cleanliness, maintenance and upkeep. 3. Summarize the medical, social, educational, vocational and other professional services received by the ward during the reporting period: Samuel is retired. He is recuperating from recent hip surgery and receives bi-weekly physical therapy; he takes medications for diabetes, high blood pressure, heart disease and pain associated with osteoporosis. He has monthly doctor appointments to monitor medications. Additionally, a home health nurse visits weekly to set up his medications. Samuel reads, watches TV and enjoys activities at the senior center and periodic visits from his great-niece who lives out of state. 18

4.

If the ward is institutionalized, the results of an investigation into the nature and appropriateness of the ward's care and treatment are as follows: Ward lives in his own home. Following hip surgery in August 2007, he recuperated for three weeks in a local nursing home after which he was able to return home. 5. What changes in the mental or physical condition of the ward has the guardian observed? During the past year, Samuel experienced several episodes of memory lapses for which he is now receiving medication. The doctor indicates Samuel is in early stages of Alzheimer's disease. He had hip replacement surgery in August 2007 and now is able to walk using a cane. Other medical conditions are stable.

6.

What major problems relating to the guardianship, if any, have arisen during the reporting period? A former neighbor who had exploited Samuel attempted to reintroduce himself into Samuel's life. Guardian secured a restraining order against the person. No other problems were experienced. 7. In the opinion of the guardian, does the guardianship need to continue, and is it necessary to increase or decrease the powers of the guardian? The guardian has advocated and provided consents regarding health care, home maintenance and freedom from exploitation. Guardianship should continue with the current powers. 8. Compensation requested and expenses incurred by the guardian: Refer to itemized list attached. 9. Other information required by the court is:

SAMPLE

I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct. Executed on June 30, 2008.

________________________________ Guardian

19

IN THE DISTRICT COURT OF

JUDICIAL DISTRICT COUNTY, KANSAS

In the Matter of the (Guardianship)/(Conservatorship) of Case No. _________

Proceeding Pursuant to K.S.A. Chapter 59

AFFIDAVIT OF COMPLETION OF BASIC INSTRUCTIONAL PROGRAM I declare that I have received and reviewed the Basic Instructions for Guardians and Conservators and kept a copy of those Instructions. I acknowledge that, as guardian and/or conservator, I have the duties and responsibilities described in the Instructions. I declare under penalty of perjury that this is true and correct. Executed on this day of , .

Signature

Please Print Your Name

Address

Telephone Number