Guardians Report (Montgomery) {17.7}

FORM 17.7 226 GUARDIAN222S REPORT //1 PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. McCOLLUM, JUDGE GUARDIANSHIP OF: CASE NO.: GUARDIAN222S REPORT [R.C. 2111.49; SUP.R. 66.05(B)(2)] NOTE: If allotted space is inadequate to respond, write 223See Exhibit224 in the space and add appropriate exhibit letter sequence, then attach exhibit containing information requested for that space. 1.This is the (circle one): 1st2nd 3rd 4th 5th 6th or Guardian222s Report. 2.Ward222s present address:City State Zip Telephone ( ) 3.Ward222s living arrangements at the above address are best described as:a. The ward222s own apartment or home (includes assisted living facilities)b. Private home or apartment of:(1) the ward222s guardian(2) a relative of the ward, whose name is:and relationship is: (3) a non-relative whose name is:c. A foster, group, or boarding homed. A nursing homee. A medical facility or state institutionf. 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 authorizedto give information to the Court about the ward.NameTelephone ( )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)CityState ZipTelephone ( ) American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. (Knowingly giving false information on a Probate document is a criminal offense.) [R.C. 2921.13(A)(11)] FORM 17.7 226 GUARDIAN222S REPORT /1/1 5.Guardian222s contact with the ward:a.Approximate number of times the guardian had contact with the ward during the period covered by thisreport: b.The nature of those contacts (phone, personal, other) c.Date the ward was last seen by the guardian:6.Have you observed any major change in the ward222s physical or mental condition during the period covered bythis report? Yes No If 223Yes224 is checked, briefly describe the changes: 7.The care given to the ward is AdequateNot AdequateIf 223Not Adequate224 is checked, explain: 8.The guardianship should be ContinuedNot ContinuedIf 223Not Continued224 is checked, explain: 9.During the period covered by this report, the ward hashas not been seen by a physician. If theward has been seen, the last date was , for the purpose of . 10. I currently serve as the guardian to ten or more wards and certify to the Court that I am unaware of anycircumstances that may disqualify me from serving as guardian for this ward. 11.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 mental retardation 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: Attorney222s Signature Attorney222s Printed Name Address City State Zip Code Telephone Number Attorney Registration Number Date: Guardian222s Signature Guardian222s Printed Name Address City State Zip Code Telephone Number Guardian222s Email Address American LegalNet, Inc. www.FormsWorkFlow.com