Guardian Of Persons Annual-Tri-Annual Report On Ward {130}

IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY, ILLINOIS ­ IN PROBATE IN RE THE ESTATE OF _________________________________________ Name of disabled adult CASE NO: __________________________ Respondent, A Disabled Adult GUARDIAN OF PERSON'S ANNUAL/TRI-ANNUAL REPORT ON WARD Pursuant §11a-17(b) of the Probate Act of 1975, ________________________________________, as Name of Guardian of person plenary guardian of the person of the above-named ward, submits this report as follows: 1. The last report to the court was made on _____________________________, 20_____. 2. Age of ward: ____________________ Mental condition: _____________________________________ Physical condition: ____________________________________________________________________ Social condition: ______________________________________________________________________ 3. Present living arrangement of the ward: Address: _____________________________________________ Other residences since last report: Address: _____________________________________________ _____________________________________________ Length of Stay: ___________________________________ ___________________________________ Length of Stay: ___________________________________ 4. Medical, educational, vocational, and other professional services given to ward by others: Diagnoses: __________________________________________________________________________ Physician: ________________________________ Date of last medical exam: ____________________ Education/Vocational/Professional services for ward: ________________________________________ ___________________________________________________________________________________ ANDREA LYNN CHASTEEN, CLERK OF THE CIRCUIT COURT OF WILL COUNTY 130 - Part 1 (Revised 12/16) American LegalNet, Inc. www.FormsWorkFlow.com 5. The Guardian's visit with and activities on behalf of the ward: Visits by guardian: ____________________________________________________________________ Staffings/reviews attended: _____________________________________________________________ 6. Appropriateness of placement: 7. The guardian does/does not recommend that the guardianship continue. (Circle one) 8. Other information considered useful in the opinion of the guardian: _________________________________________________ (Signature of Guardian) Address of Guardian:_______________________________ _________________________________________________ Guardian of _______________________________________ Name of disabled adult CERTIFICATION I affirm under penalty of perjury that I have read the foregoing document, that I know the contents thereof, and that the same are true and correct to the best of my knowledge and belief. _________________________________________________ (Signature of Guardian) Prepared By: Attorney _______________________________________ Firm __________________________________________ ARDC# _______________________________________ Address ________________________________________ City and Zip ____________________________________ Telephone ______________________________________ ANDREA LYNN CHASTEEN, CLERK OF THE CIRCUIT COURT OF WILL COUNTY American LegalNet, Inc. www.FormsWorkFlow.com 130 ­ Part 2 (Revised 12/16)