Free Conservator's Report - District of Columbia

II-R

SUPERIOR COURT OF THE DISTRICT OF COLUMBIA
PROBATE DIVISION IN RE: ___________________________________________ An Adult ___________________________________________ (Address) ___________________________________________ CONSERVATOR'S REPORT Intervention Proceeding No. _______________

Name of conservator ______________________________________________________ Address ________________________________________________________________ ________________________________________________________________________ Describe significant changes, if any, in the capacity of the subject of this proceeding to meet the essential requirements for his or her physical health or safety: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ The services being provided to the subject of this proceeding are: ____________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ The significant actions taken by the conservator during this reporting period are: _______________________________________________________ ________________________________________________________________________ ________________________________________________________________________

2. The significant problems relating to the conservatorship which have arisen during the reporting period are: ____________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ The reasonable and necessary expenses incurred by the conservator are as follows: ___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ The reason, if any, why the appointment should not be terminated or why no less restrictive alternative will permit the subject of this proceeding to meet the essential requirements for his or her physical health or safety are: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Attached is an accounting of the financial resources under the control and/or of the conservator for the period indicated. I certify that notice of the filing of this report and account has been sent to the following persons (name): The subject of this proceeding: The attorney of record : The guardian : The individuals most closely related to the subject of the intervention proceeding by blood or marriage : The guardian ad litem, if any :

3. The individual (s) , if any, appointed or proposed by appointment as guardian ad litem: The individual or facility, if any, having custody of the subject of the intervention proceeding : The Veterans' Administration (Veterans' Affairs Officer) : I further certify that this report has been explained to the subject of this intervention proceeding.

_________________________________ (Signature of Conservator)

Form PD-1902C/Sep. 89