Free STATE OF MINNESOTA - Minnesota

M.S. § 524.5-316

State of Minnesota
Select County County of ___________________

District Court Probate Division Judicial District: ____________________ Court File No. _______________________ Case Type: 14, Guardianship

In Re: Guardianship of __________________________, Ward

PERSONAL WELL-BEING REPORT
(Annual Report of Guardian)

As required by M.S. § 524.5-316 the Guardian makes this Annual Report for the period from ______________ to __________________. Instructions: Complete all paragraphs. Attach additional sheets if necessary. 1. The current mental, physical and social condition of the Ward is: (a) Mental: _________________________________________________________. (b) Physical:________________________________________________________. (c) Social: _________________________________________________________. 2. The addresses and types of all living arrangements for the Ward in the past year: _____________________________________________________________________ _____________________________________________________________________. Medical, educational, vocational and other services provided to the Ward in the past year: _______________________________________________________________________. My opinion of the adequacy of the care given to the Ward in the past year: _______________________________________________________________________. Recommendation regarding continuation of the guardianship or scope of the guardianship: __________________________________________________________ _____________________________________________________________________. I have personally seen the Ward _________ times in the past year.

3.

4.

5.

6.

I _________________________________________________________________, being duly sworn, state that 1) this is an accurate statement of the Ward's well being and care for the period indicated above; 2) I have given a copy of this report to the Ward; and 3) the annual notice of right to petition has been given to the ward or protected person by ____ MAIL or ____ PERSONALLY by __________________ (by whom served). Dated:_______________ Sworn/affirmed before me on . ________________________________________ Signature of Guardian Name: ___________________________(Print) Address: ___________________________

__________________________________
Notary Public \ Deputy Court Administrator

City/State/Zip: _________________________
Telephone: __________________________

FILE THE ORIGINAL OF THIS PAGE WITH THE COURT

GAC 11-U State

ENG

Rev 8/05

www.courts.state.mn.us/forms 1

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M.S. § 524.5-316

State of Minnesota County of ___________________

District Court Probate Division Judicial District: ______________________ Court File No. _________________________ Case Type: 14, Guardianship

Guardianship and In Re: Conservatorship of ________________________________, Ward / Protected Person

Annual Notice of Right to Petition for Restoration to Capacity

To:_____________________________________________ Ward / Protected Person You have a right to ask the Court to end the guardianship or conservatorship or to modify the guardianship or conservatorship by filing a petition with the Court explaining why you believe the guardianship or conservatorship should end or be modified. You have a right to object to the Guardian's change in your place of residence, and you have a right to ask the Court for a change of residence, by filing a petition with the Court explaining why the change should or should not be made. If you wish to have a different guardian or conservator then you must file a petition for removal of the guardian or conservator, explaining why you believe the present guardian or conservator should be removed. To petition the court you may call the Court Monday through Friday between 8:00 a.m. and 4:30 p.m. and ask that a form be sent to you or pick up the proper form at the Court and file it there. The address of the Court is: ___________________________________________________________ __________________________________________________________________________________ and phone number is _________________________________________. After a petition is filed the Court will schedule a hearing. You have the right to be present at that hearing and to have a lawyer represent you. If you cannot afford a lawyer, the Court will appoint one for you. You can call the Court to request a Court appointed attorney.

You retain the right to vote unless your guardian informs you that the court terminated your right to vote. This notice must be served annually on the ward or protected person within thirty days after the anniversary of the appointment of the guardian or conservator.

THIS PAGE MUST BE GIVEN TO THE WARD/PROTECTED PERSON

GAC 11-U State

ENG

Rev 8/05

www.courts.state.mn.us/forms 2

Page 2 of 2