Fillable GUARDIANS ANNUAL REPORT FOR ADULT GUARDIANSHIP (Vermont Judiciary)

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GUARDIANS ANNUAL REPORT FOR ADULT GUARDIANSHIP (Vermont Judiciary)

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700-00093A – Guardian’s Annual Report on Adult Guardianship (08/2018) Page 1 of 2
STATE OF VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No.:
In re Guardianship of :
GUARDIAN’S ANNUAL REPORT FOR ADULT GUARDIANSHIP
The following is a report to the Court concerning
Name of Respondent
for the period
beginning
.
I hereby state under oath that the following facts are true concerning the Respondent who is
under my guardianship.
1. Respondent’s current address:
Mailing Address
*Physical Address (if different)
Respondent resides in (check one):
☐ Private Home
☐ Nursing Home
☐ Group Home
☐ Rehabilitation Facility
☐ Other (describe)
2. Respondent’s current health and health care needs: (describe all aspects of health care for
Respondent including his/her physical health, mental health and dental care.)
3. Respondent’s educational and employment activities:
Age of Respondent
*Please provide name of residential provider and address if respondent does not reside with the guardian.
700-00093A – Guardian’s Annual Report on Adult Guardianship (08/2018) Page 2 of 2
4. My activities as guardian for the Respondent:
5. Respondent’s Financial Assets:
I ☐ am ☐ am not managing the Respondent’s financial assets.
If you are only managing Respondent’s social security benefits, attach the most recent
Representative Payee Report you filed with Social Security (Form # SSA-623-OCR-SM). If you
are managing other assets for the Respondent, an annual summary of account must be filed
with this report.
6. Recommendations for changes to Guardianship Order:
I recommend that the Guardianship Order be changed: ☐ Yes ☐ No
If Yes, attach a request to modify or amend Guardianship Order.
Date
Signature of Guardian Signature of Co-Guardian, if any
Guardian’s Mailing Address
Co-Guardian’s Mailing Address
Guardian’s Phone Number
Co-Guardian’s Phone Number
Subscribed and sworn before me on:
date
My commission expires on:
Date of Expiration
Signature of Notary
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GUARDIANS ANNUAL REPORT FOR ADULT GUARDIANSHIP (Vermont Judiciary)

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Completed 30 July 2020

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