Revised 3/2020 Page 1 of 5
Once completed please mail back to
Attn: Probate Court 1450 E. McKinney Suite 2412 Denton, Texas 76209
CAUSE NO.: __________________
IN RE: GUARDIANSHIP
§
IN THE PROBATE COURT
§
OF THE PERSON OF
§
OF
§
______________________
§
DENTON COUNTY, TEXAS
Please answer each question as completely as possible. All questions must be answered, use n/a if question does not
apply. Incomplete reports will delay the issuance of Letters of Guardianship.
ANNUAL REPORT OF CO-GUARDIANS OF THE PERSON
Now comes _______________ and _______________, Co-Guardians of
__________________, Ward (hereinafter referred to as “Protected Person”) in the above entitled and
numbered cause, and files this report covering the time period of _______________, 20____
through _______________, 20____ concerning the Protected Person’s physical well-being,
location, and condition pursuant to Section 1163.101 of the Texas Estates Code.
1. Protected Person’s name: __________________________________________________
2. Protected Person’s date of birth and age: ______________________________________
3. Protected Person’s address:__________________________________________________
_________________________________________________________
4. Protected Person’s phone number: ___________________________________________
5. Co-Guardians’ name: _____________________________________________________
6. Co-Guardians’ address: ___________________________________________________
___________________________________________________
(If Co-Guardians reside separately, provide both addresses.)
___________________________________________________
7. Co-Guardians’ phone number(s): ____________________________________________
8. Co-Guardians’ email address(es): ____________________________________________
9. Co-Guardians’ relationship to Protected Person: ________________________________
10. Check the type of residence in which the Protected Person lives:
Guardian’s home (If Co-Guardians reside separately, identify which Co-Guardian is
the custodial Co-Guardian.) _______________________________
Protected Person’s own home
Denton State Supported Living Center
Nursing home (Name of facility): _________________________________________
Group home (Company Name): __________________________________________
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Attn: Probate Court 1450 E. McKinney Suite 2412 Denton, Texas 76209
Other (adult foster-care, etc.): ____________________________________________
11. How long has the Protected Person resided at his/her current residence? _____________
12. Has the Protected Person’s residence changed in the last twelve months?
No Yes
If yes, please provide the date of change and the reason for the change:
________________________________________________________________________
________________________________________________________________________
13. As the Co-Guardians do you believe the Protected Person is content with his/her living
arrangements?
Yes No
If no, please provide a brief explanation: ______________________________________
________________________________________________________________________
14. As the Co-Guardians do you believe the Protected Person has any unmet needs?
No Yes
If yes, please provide brief explanation: _______________________________________
15. As the Co-Guardians we rate the Protected Person’s living conditions as:
Excellent Average Below Average
If below average, please explain: ____________________________________________
________________________________________________________________________
As the Co-Guardians we have taken the following steps to improve the living conditions:
________________________________________________________________________
________________________________________________________________________
16. As the Co-Guardians we rate the Protected Person’s day to day care as:
Excellent Average Below Average
If below average, please explain: ____________________________________________
________________________________________________________________________
As the Co-Guardians I have taken the following steps to improve the day to day care:
________________________________________________________________________
________________________________________________________________________
17. The Protected Person’s primary physician is: ___________________________________
18. Check the appropriate box if the Protected Person has been seen by any of the following
health care providers within the last year:
Psychiatrist: Name __________________ Treated for: _______________________
Psychologist: Name _________________ Treated for: _______________________
Dentist: Name _____________________ Treated for: _______________________
Other: Name ______________________ Treated for: _______________________
Revised 3/2020 Page 3 of 5
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Attn: Probate Court 1450 E. McKinney Suite 2412 Denton, Texas 76209
19. During the past year the Protected Person’s physical health has:
remained the same
improved
deteriorated
If improved or deteriorated, please explain: ____________________________________
________________________________________________________________________
20. During the past year the Protected Person’s mental health has:
remained the same
improved
deteriorated
If improved or deteriorated, please explain: ____________________________________
________________________________________________________________________
21. Does the Protected Person have an estate? (SSI benefits are not an estate)
No Yes
If yes, are you the Co-Guardians of the Protected Person’s estate? Yes No
If yes, have you filed your Annual Account? Yes No
22. Do you receive money for acting as the Protected Person’s Co-Guardians?
Yes No
23. Do you or the Protected Person receive any funds for the Protected Person’s care? Please
identify all that apply.
SSI: Amount: ______________ SS Survivor Benefits: Amount: _______________
SSDI: Amount: _____________ Trust Account: Amount:_______________
VA: Amount: ______________ Other: Amount: _________________
24. Are you the representative payee and/or the person that handles the Protected Person’s
funds? Yes No
If No, please state who the rep. payee is: ___________________________________
25. If you handle funds for the Protected Person’s care, in what kind of account are the funds
maintained?
Separate designated account: Yes No
Joint account with Protected Person: Yes No
Other: Please identify: ____________________________________________________
26. When the Guardianship was granted, we as the Co-Guardians posted a:
personal surety bond cash bond corporate bond
If a corporate bond was posted have you paid the premium for the next reporting period?
Yes No
Revised 3/2020 Page 4 of 5
Once completed please mail back to
Attn: Probate Court 1450 E. McKinney Suite 2412 Denton, Texas 76209
27. As the Co-Guardians we believe our Guardianship powers should:
remain the same
be increased
be decreased
If increased or decreased is selected please explain: _____________________________
________________________________________________________________________
28. The Denton County Probate Court has a standing requirement for all Guardians to have
face-to-face visits at the Protected Person’s residence a minimum of four times per year
spread throughout the year.
As the Co-Guardians have you met this requirement? (If the Co-Guardians reside
separately, identify how often each Co-Guardian visits the Protected Person.)
Yes No: Please explain why you have not visited: ________________________
________________________________________________________________________
We reside with the Protected Person; or we visit weekly every other week
monthly
Please list the dates of visits if different from the choices above. ___________________
________________________________________________________________________
29. During the past year the Protected Person has participated in the following activities:
Recreational: (list activities) _____________________________________________
Educational: (list activities) ______________________________________________
Social: (list activities) __________________________________________________
Occupational: (list activities) ____________________________________________
Limited ability to participate but enjoys: (list activities) _______________________
________________________________________________________________________
30. Does the Protected Person receive any community services and/or resources (i.e. Denton
County MHMR Waiver Programs, STAR+ Waiver, Private/Insurance Pay)?
Yes No: If yes, please provide a case manager name and contact number:
applicable: _____________________________________________________________
31. Texas Estates Code §1151.351 requires Guardians each year on annual renewal of the
Guardianship to explain the rights delineated in the “Ward’s Bill of Rightsin the Protected
Person’s native language, or preferred mode of communication, and in a manner accessible
to the Protected Person. In addition to explaining those rights, the Court requires Guardians
each year to provide a copy of the Bill of Rights to the Protected Person. Have you, as Co-
Guardians, explained the rights delineated in the Bill of Rights and provided the Protected
Person a copy of the Bill of Rights?
Yes No
Revised 3/2020 Page 5 of 5
Once completed please mail back to
Attn: Probate Court 1450 E. McKinney Suite 2412 Denton, Texas 76209
32.
In 2017, the Texas Legislature enacted a new law requiring all guardianships to be
registered with the Judicial Branch Certification Commission (JBCC). Effective June 1,
2018, each guardianship in Texas must be registered.
Have you registered your guardianship?
a.
Yes
b.
No Explain why:_________________________________
33. Please use this space to share any other information that you would like the Court to know
about the Protected Person and/or your role as Co-Guardians, including any new medical
issues or concerns, and whether you the Co-Guardians have filed an Application for
Emergency Detention of the Protected Person, and if applicable, the number of times and
dates of the applications):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
UNSWORN DECLARATION
We_______________________ and _______________________, Co-Guardians of the Person
for _______________________ in Denton County, Texas declare under penalty of perjury that
the foregoing is true and correct.
Executed on the____ day of __________, 20____.
(date) (month)
___________________________ ___________________________
Signature of Declarant/Guardian Signature of Declarant/Co-Guardian
____________________________ ____________________________
Printed Name of Declarant/Guardian Printed Name of Declarant/Co-Guardian