Conservators Report {PD 1902C}

SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION _________ INT _________ _________ IDD _________ In re: ________________________________ An Adult CONSERVATOR'S REPORT Name of conservator: _________________________________________________________________________ Address of conservator: _________________________________________________________________________ _________________________________________________________________________ Describe significant changes, if any, in the capacity of the subject of this proceeding to meet the essential requirements for the subject's 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: ________ _________________________________________________________________________ _________________________________________________________________________ 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: ______________ _________________________________________________________________________ _________________________________________________________________________ April 2014 ­ 903.10.v2 American LegalNet, Inc. www.FormsWorkFlow.com 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 the subject's physical health or safety are: ______________________________________ _________________________________________________________________________ _________________________________________________________________________ Attached is an accounting of the financial resources under the control of the conservator for the period indicated. VERIFICATION I, ____________________________, being first duly sworn, on oath, depose and say that that I have read the foregoing pleading by me subscribed and that the facts therein stated are true to the best of my knowledge, information, and belief. _______________________________________ Signature of conservator _______________________________________ Typed name of conservator _______________________________________ Address (actual address/not Post Office Box) _______________________________________ _______________________________________ _______________________________________ Telephone number _______________________________________ Email address _______________________________________ Unified Bar number (if conservator is an attorney) Subscribed and sworn to before me this ____ day of _________________, 20______. _______________________________________ Notary Public/Clerk April 2014 ­ 903.10.v2 American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF SERVICE I certify that on the ____ day of ____________________, 20____, a copy of this filing was either eServed in accordance with the provisions of Administrative Order 13-15 or served by first class mail, postage prepaid, on the following persons (list names and complete mailing addresses): _________________________________ Signature April 2014 ­ 903.10.v2 American LegalNet, Inc. www.FormsWorkFlow.com