Guardians Report {17.7}

PROBATE COURT OF LAKE COUNTY, OHIO MARK J. BARTOLOTTA, JUDGE GUARDIANSHIP OF _________________________________________________________ CASE NO. __________ GUARDIAN'S REPORT [R.C. 2111.49 and Sup.R. 66.05(B)(2)] NOTE: If allotted space is inadequate to respond, write "See Exhibit" in the space and add appropriate exhibit letter sequence, then attach exhibit containing information requested for that space. 1. 2. This is the (circle one) 1st, 2nd, 3rd, 4th, 5th, 6th, or _________, Guardian's Report. Ward's present address:_______________________________________________________________ City __________________________________ State ___________________ Zip Code_____________________Telephone Number (____)______________ 3. Ward's living arrangements at the above address are best described as: a. His or her own apartment or home (includes assisted living facilities.) b. Private home or apartment of: (1) the ward's guardian (2) a relative of the ward, whose name is _____________________________________ and relationship is ______________________________________________________ (3) a non-relative whose name is ___________________________________________ c. d. A foster, group, or boarding home. A nursing home. e. A medical facility or state institution. f. Other (describe) ___________________________________________________________ ____________________________________________________________________________ g. If c, d, e, or f is checked, complete the following: (1) The name of the home, facility, or institution __________________________________ (2) The name of an individual at the home, facility, or institution who has knowledge and is authorized to give information to the court about the ward. Name ________________________________________________________________ Telephone Number (_____)_______________________________ 4. The ward will be at the address given in Item 2: a. Indefinitely. b. Temporarily. The new address and telephone number is: (1) Unknown. I will provide this information when known. (2) ______________________________________________________________________ City ______________________________________________ State __________________ Zip Code ________________ Telephone Number (____)___________________________ American LegalNet, Inc. www.FormsWorkFlow.com FORM 17.7 - GUARDIAN'S REPORT Amended: March 1, 2017 [Reverse of Form 17.7] CASE NO.__________ 5. Guardian's contact with the ward. a. b. c. 6. Approximate number of times the guardian had contact with the ward during the period covered by this report: _________________ The nature of those contacts (phone, personal, or other): ______________________________ ____________________________________________________________________________ Date the ward was last seen by the guardian: _______________________________________ Have you observed any major change in the ward's physical or mental condition during the period covered by this report? Yes No If "yes" is checked, briefly describe the changes.____________________________________________ __________________________________________________________________________________ 7. __________________________________________________________________________________ The care given to the ward is Adequate Not Adequate If "Not Adequate" is checked, explain. ____________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 8. The guardianship should be Continued Not Continued If "Not Continued" is checked, explain. ___________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 9. During the period covered by this report, the ward has has not been seen by a physician. If the ward has been seen, the last date was _______________________________________________ and for the purpose of ____________________________________________________________________ 10. 11. I currently serve as the guardian to ten or more wards and certify to the Court that I am unaware of any circumstances that may disqualify me from serving as guardian for this ward. With regard to the continuing education requirement pursuant to Sup.R. 66.07: I have completed the continuing education requirement. (Attach Certificate of Completion if applicable) The continuing education requirement was waived. Attached is a statement by a licensed physician, a licensed clinical psychologist, a licensed social worker, or a developmental disability team, that has evaluated or examined the ward within three months prior to the date of this report regarding the need for continuing the guardianship. [R.C. 2111.49(A)(1)(I)](Form 17.1) If an attorney has been consulted on this report: _____________________________________ Attorney for Guardian _____________________________________ Street _____________________________________ City State Zip Code _____________________________________ Telephone Number (include area code) _____________________________________ Attorney Registration No. Date _______________________________________ ____________________________________________ Guardian's Printed Name ____________________________________________ Guardian's Signature ___________________________________________ Street ____________________________________________ City State Zip Code ____________________________________________ Telephone Number (include area code) (Knowingly giving false information on a Probate document is a criminal offense) [R.C. 2921.13(A)(11)] FORM 17.7 - GUARDIAN'S REPORT PAGE 2 American LegalNet, Inc. www.FormsWorkFlow.com Amended: March 1, 2017