Form PAG152 Adult Guardian Closing Report and Discharge Order (9/2014) Page 1 of 1
STATE OF VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No.:
ADULT GUARDIAN CLOSING REPORT and DISCHARGE ORDER
The following is a final report to the court concerning
Name of Respondent
I hereby report under oath that the following facts are true:
1. This report is filed within one year after the final accounting in this proceeding.
2. Persons entitled to money or other property have been paid in the amounts set forth in the final
accounting.
3. A receipt for each payment is attached to this report together with proof of delivery or other
proof as required by the Court.
Based on this report, I request that I be discharged and that this proceeding be closed.
Date
Signature of Guardian
Signed and sworn to before me:
Date
Signature of Notary Public
Expiration Date
DISCHARGE ORDER
Report approved and proceeding closed. The Guardian is hereby discharged.
Dated:
Signed
Probate Judge