Free Guardian's Annual Report - Missouri

IN THE PROBATE DIVISION, CIRCUIT COURT, ST. LOUIS COUNTY, MISSOURI No. In the matter of U
Incapacitated/Disabled Person

u

GUARDIAN'S ANNUAL REPORT I, , Guardian of the

above named ward submit the following information as required pursuant to the provisions of 475.082 R.S. Mo 1985.u The present address of the ward is u . My present address is u .u During the past year I contacted the ward The nature and description of my contacts with the ward ­ times. u u .u Date I last saw the ward was The ward is currently institutionalized in .u u

_____________________________________________________________. (If not institutionalized, so state.) As Guardian have you received a copy of the treatment or rehabilitation plan? Yes _____ No _____. If the answer is yes, attach a copy to this report. Do you agree with its provisions? Yes _____ No _____. The date the ward was last seen by a physician is . The purpose of the

visit by a physician was ____________________________________________________________________ .u I have observed the following major physical or mental conditions of the ward (if none, so state): ________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________

I feel that the continuation of the guardianship is/is not needed for the following reasons: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ My opinion as to the adequacy of the card of the ward is as follows: _______________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________. My opinion as to the facility where the ward is residing is as follows: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________. Comments:

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u U U U .U

Return To: St. Louis County Probate Court 7900 Carondelet, Fifth Floor Clayton, MO 63105

Signed this

day of

, 20

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U Signature of Guardian U Typed Name of Guardian u Street Address u City State Telephone Number Zip Code u

IN THE PROBATE DIVISION, CIRCUIT COURT, ST. LOUIS COUNTY, MISSOURI
REQUIRED INFORMATION (Supreme Court Rule 21.06 requires that we obtain social security numbers and dates of birth for parties in Probate Cases. THIS INFORMATION IS KEPT CONFIDENTIAL ­ ONCE ENTERED INTO SYSTEM, THIS SHEET IS DESTROYED BY SHREDDING.) **If previously submitted with prior reports, not necessary to complete.**

In the Estate of _______________________________ No. ____________ Guardian Last Name: __________________ First Name:_______________ Middle Name or Initial: ______________ Address: _____________________________________________ City: ________________ State: ____ DOB: _________________
(required)

Zip: _______________
(required)

SSN: ____________________

Guardian Last Name: __________________ First Name:_______________ Middle Name or Initial: ______________ Address: _____________________________________________ City: ________________ State: ____ DOB: _________________
(required)

Zip: _______________
(required)

SSN: ____________________

Ward or Minor Last Name: __________________ First Name:_______________ Middle Name or Initial: ______________ Address: _____________________________________________ City: ________________ State: ____ DOB: _________________
(required)

Zip: _______________
(required)

SSN: ____________________