Free 790 - Kentucky

AOC-790 Rev. 12-03 Page 1 of 3

Doc. Code: RGD
01/9/2007 11:45 am Ver. 1.01

leave blank if unknown

Case No.______________________ Court_________________________

Commonwealth of Kentucky Court of Justice
www.kycourts.net

KRS 387.670

ANNUAL REPORT OF GUARDIAN

County_______________________

COMMONWEALTH OF KENTUCKY

VS.

_____________________________________________ RESPONDENT

) ) ) ) ) ) ) )

************
I, the undersigned, state that I am the [ ] Guardian [ ] Limited Guardian of the above-named Respondent, and report to the Court as follows: 1. 2. 3. 4. Present age of Ward:___________________________________. Date of birth:__________________________________________. Current address of Ward:________________________________________________________________________. Ward's present living arrangment is: [ ] Own home [ ] Guardian's home [ ] Hospital [ ] Relative's home ___________________ Relationship [ ] Other:____________________________________________________________________________________________ 5. Ward has been at present residence since____________________________________________________________. If Ward has lived elsewhere during the reporting period, list description and address of each residence and the length of stay at each. ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ [ ] Nursing home [ ] Skilled care [ ] Intermediate care [ ] Personal care

AOC-790 Rev. 12-03 Page 2 of 3 6.

Doc. Code: RGD

During this reporting period, the Ward's mental condition has: [ ] Remained about the same. [ ] Improved. Describe:________________________________________________________________________ ________________________________________________________________________________________ [ ] Deteriorated. Describe:______________________________________________________________________ ________________________________________________________________________________________

7.

During this reporting period, the Ward's physical health has: [ ] Remained about the same. [ ] Improved. Describe:________________________________________________________________________ ________________________________________________________________________________________ [ ] Deteriorated. Describe:______________________________________________________________________ ________________________________________________________________________________________

8.

During this reporting period, the Ward's social condition has: [ ] Remained about the same. [ ] Improved. Describe:________________________________________________________________________ ________________________________________________________________________________________ [ ] Deteriorated. Describe:______________________________________________________________________ ________________________________________________________________________________________

9.

During this reporting period, the Ward has received the following services: Medical: Educational: Social: Vocational: Other: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

10.

My visits and activities on behalf of the Ward were: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________

AOC-790 Rev. 12-03 Page 3 of 3

Doc. Code: RGD

11.

The guardian [ ] should [ ] should not be continued or modified for the following reasons: ____________________________________________________________________________________________ ____________________________________________________________________________________________

12.

I [ ] do [ ] do not have responsibility for managing the Ward's estate. If so, an accounting of the estate [ ] is attached [ ] was filed last year. A standby guardian [ ] has [ ] has not been appointed.

13.

_________________________________________ Date _________________________________________ Guardian's Phone Number _________________________________________ Guardian's Social Security Number

_____________________________________________ Guardian _____________________________________________

_____________________________________________ Address

************
SUBSCRIBED and SWORN to before me this______________day of____________________________, ________. My Commission expires:____________________________________________.

_____________________________________________ Notary Public

************
To be signed by Standby Guardian if one is appointed. I, the undersigned, state that I am the Standby Guardian of the above-named Respondent and continue to be willing to serve in the event of the death, resignation, removal or incapacity of the Guardian.

_________________________________________ Date _________________________________________ Standby Guardian's Phone Number _________________________________________ Standby Guardian's Social Security Number

_____________________________________________ Signature of Standby Guardian _____________________________________________

_____________________________________________ Address

Print

Reset Form