Annual Report Of Guardian Of Minor {MPC 443}

ANNUAL REPORT OF GUARDIAN OF MINOR In the Interests of: First Name Middle Name Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court Division Last Name Minor Child's name, date of birth and address: First Name Middle Name Last Name (Date of Birth) (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Each guardian's name and address: 1. First Name M.I. Last Name (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) 1. Please list the names, ages and relationship to you of all persons currently living in your household: First Name 1. 2. 3. 4. 5. 6. 2. Have you been investigated for abuse or neglect since the last report or since you were in court? Yes No M.I. Last Name Age Relationship If YES, please state the date(s), circumstances, investigating agency, outcome and any information regarding court involvement such as the name of the court and docket number of the case: 3. Has the child moved since your last report or since you were last in court? If YES, please explain: Yes No MPC 443 (5/30/11) page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 4. Is the child currently in school? If NO, and the child is over age 6, please explain: Yes No If YES, please answer the following: What grade is the child in? How is the child doing in school? Please describe the child's grades and any special services the child is receiving in school: 5. Has the child's physical, psychological or medical condition changed since the last report? Has he/she been hospitalized or injured? If YES, please explain: Yes No 6. Does the child have contact with his or her parent(s)? If YES, how frequently, how recently, is it regular, and what is the quality of the contact? Yes No 7. Has the child been involved in any court cases since the last report or since you were last in court? For example - delinquency or criminal charges, CHINS petition? If YES, please explain: Yes No 8. Please provide any other information you believe will assist the court in reviewing the child's general well being. (Attach additional pages if needed) MPC 443 (5/30/11) page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com SIGNED UNDER THE PENALTIES OF PERJURY I affirm or swear under oath that I have read the foregoing petition and that the statements set forth therein are true and correct to the best of my knowledge. Date Signature of Guardian Date Signature of Co-Guardian (if applicable) Attorney for Guardian: Print Name (Address) (City/Town) (State) (Apt, Unit, No. etc.) (Zip) Primary Phone #: BBO No.: MPC 443 (5/30/11) page 3 of 3 www.FormsWorkFlow.com