Fillable IN THE SUPERIOR COURT FOR THE STATE OF (State of Alaska)

Fill Online, Printable, Fillable, Blank IN THE SUPERIOR COURT FOR THE STATE OF (State of Alaska) Form

Use Fill to complete blank online STATE OF ALASKA (AK) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

IN THE SUPERIOR COURT FOR THE STATE OF (State of Alaska)

On average this form takes 126 minutes to complete

The IN THE SUPERIOR COURT FOR THE STATE OF (State of Alaska) form is 18 pages long and contains:

  • 0 signatures
  • 32 check-boxes
  • 491 other fields

Country of origin: US
File type: PDF

U.S.A. forms for State of Alaska

BROWSE STATE OF ALASKA (AK) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f)
AS 13.26.276 - .286, .510, .570 & 13.06.100
Page 1 of 12
PG-215 (4/17)(cs)
FINAL GUARDIANSHIP REPORT
IN THE SUPERIOR COURT FOR THE STATE OF ALASKA
AT____________________
In the Matter of the Protective Proceedings of: )
)
Name of Ward: )
)
Date of Birth: )
)
Residential location of ward: )
)
) CASE NO.
Ward’s Telephone #: )
) FINAL GUARDIANSHIP REPORT
Instructions To Guardian
Please type or print clearly using black ink. In preparing the report, you must consult with the
ward as much as possible (if the ward is still living). The court will treat the information in this
report as confidential.
If you are unable to complete this form without help, you may find assistance on the website
of the Office of Public Advocacy (OPA): http://doa.alaska.gov/opa/pg/pub_guard.html. Your
local library and court may also have a binder of helpful information entitled “Family
Guardian Education Materials,” prepared by the Alaska State Association for Guardianship
and Advocacy. You may also call OPA at 269-3500 (in Anchorage), 451-5933 (in Fairbanks) or
1-877-957-3500.
After completing this report, you must sign it under oath (or affirmation) in the presence of a
notary public or court clerk. See last page.
If you were a full guardian with the powers of a conservator, you must fill out the entire form.
If you were a partial guardian and did not have the powers of a conservator (or if a separate
conservator was appointed), you do not need to fill out the financial information in paragraphs 10
through 17. The purpose of this report is to tell the court why your service as guardian is ending
and what has happened to the ward and the ward’s assets since you filed your last annual report.
Reporting Period
This report covers the period: From the end of the last reporting period:
To the date my services as guardian ended:
Information About Guardian
Guardian’s Name Daytime Phone
Mailing Address
(box or street number) (city) (state) (ZIP)
Check here if this mailing address is new.
Relationship to ward:
Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f)
AS 13.26.276 - .286, .510, .570 & 13.06.100
Page 2 of 12
PG-215 (4/17)(cs)
FINAL GUARDIANSHIP REPORT
In what areas did you have the authority to make decisions for the ward? housing
medical care school & job training employment social & recreational activities
financial management (you controlled ward’s finances because you had conservator powers)
Was a separate conservator appointed for the ward?
No Yes Name:
Reason For Ending Guardianship
My guardianship of the ward has ended because:
The ward died on at
(date) (location)
A copy of the death certificate is attached.
I
did did not have possession of the ward’s will.
On , 20 , I delivered the ward’s will to the court
for safekeeping, as required by AS 13.26.545(e), and informed the executor or a
beneficiary named in the will that the will had been so delivered. Name of person
notified:
I resigned as guardian. A new guardian, , has been appointed.
(name)
I was removed by the court.
The court has terminated the guardianship because
Other (Explain):
If the ward is deceased or if the guardianship has been terminated because the ward
regained capacity, you need not fill out paragraphs 1-9. Skip to paragraphs 10-17. You
must fill out paragraphs 10 - 17 if you were a full guardian with authority to manage the
ward’s finances. If you did not have financial management authority, skip to the
signature section on the last page.
Information About Ward
1. Housing.
a. Where does the ward live now (name of facility or place)?
Who takes care of the ward?
Type of Residence:
nursing home assisted living home
Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f)
AS 13.26.276 - .286, .510, .570 & 13.06.100
Page 3 of 12
PG-215 (4/17)(cs)
FINAL GUARDIANSHIP REPORT
b. What is the ward’s opinion of the ward’s current living arrangements?
2. Medical Care.
a. Which of the following medical professionals has the ward seen since the last
report to the court?
Doctor’s Name
Phone No. Dates Seen
Medical Doctor
Dentist
Eye Doctor
Ear Doctor
Psychologist or
Psychiatrist
Other:
b. Describe any medical services and mental health treatment provided to the ward
since the last report to the court:
c. Are there any problems providing medical care or treatment for the ward?
d. Is a no-code (Do Not Resuscitate) provision in place for the ward? Yes No
e. Did the ward, while the ward still had the capacity to do so, execute a durable
power of attorney for health care or some other advance health care directive
Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f)
AS 13.26.276 - .286, .510, .570 & 13.06.100
Page 4 of 12
PG-215 (4/17)(cs)
FINAL GUARDIANSHIP REPORT
under AS 13.52.010 - .395 or another law? Yes No. If yes, who is the
agent authorized to make health care decisions for the ward?
3. School and Job Training.
Since the last report to the court, did the ward attend school or receive any type of job
training? No Yes. Describe studies (include name and location of school):
4. Work.
Was the ward employed at any time during the period since the last report to the court?
No Yes. Describe (include type of work, name of employer, address, phone,
and how long employed):
5. Contacts With Ward.
a. If the ward did not live with you, how often did you visit the ward in the period
since the last report to the court?
b. Were there any other contacts? No Yes, as follows:
Type of Contact How Often
by telephone
by mail or e-mail
through 3rd person:
other:
6. Decision Making.
Have there been any changes in the ward’s ability to make decisions about matters
affecting the ward’s health and safety?
7. Community Resources (service providers, churches, government programs, charitable
organizations, etc.). List the community organizations that are currently involved with
the ward.
Name of Organization Services Received Agency Phone
Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f)
AS 13.26.276 - .286, .510, .570 & 13.06.100
Page 5 of 12
PG-215 (4/17)(cs)
FINAL GUARDIANSHIP REPORT
8. Significant Actions.
Describe any significant actions you took as guardian for the ward during the period since
your last report was filed with the court:
9. Additional Information.
List any additional information about the ward that you wish to report to the court:
You only have to fill out paragraphs 10 – 17 if you were a full guardian with authority to
manage the ward’s finances. If you did not have financial management authority, skip
to the signature section on the last page.
10. Ward’s Income Since Last Annual Report. (List only the income of the ward. Do not
list your income.)
Amount Received Amt. Received
Since Last Since Last
Income Source
Annual Report Income Source Annual Report
Social Security Benefits: Wages:
a. SSA: Dividends/Interest:
b. SSI:
Rental Income:
Adult Public Assistance: Pension:
Veterans Financial Benefits:
Annuities:
Alaska Longevity Bonus: Other (describe):
Permanent Fund Dividend:
Native Corporation Dividend:
Total Income Received Since Last Annual Report:
$0.00
Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f)
AS 13.26.276 - .286, .510, .570 & 13.06.100
Page 6 of 12
PG-215 (4/17)(cs)
FINAL GUARDIANSHIP REPORT
11. Ward’s Expenses Since Last Annual Report. (Money paid to anyone on behalf of
ward or ward’s legal dependents. Do not include your personal expenses. Attach extra
pages if necessary.)
Amount Spent
Since Last
Expense
Description Annual Report
Nursing/ Assisted Living Home:
Rent Payment:
Mortgage Payment:
Utilities:
Transportation:
Medical Treatment Costs:
Medications:
Credit Card Payments:
Food:
Clothing:
Recreation or Entertainment:
Personal Expenses (include allowance):
Income Tax/Property Tax:
Home/Property Maintenance Costs:
Insurance
Home Insurance:
Auto Insurance:
Medical Insurance:
Life Insurance:
Gifts:
Child/Spousal Support:
Fees/Costs Paid to Guardian:
Burial Expenses:
Other (list all other payments made):
Total Expenses Since the Last Annual Report:
12. Money Controlled by Ward.
Since the last annual report was filed, did the ward have sole control over any money?
Yes No
If yes, please explain:
Is this money included in the income and expenses listed in #10 and #11? Yes No
Explain:
$0.00
Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f)
AS 13.26.276 - .286, .510, .570 & 13.06.100
Page 7 of 12
PG-215 (4/17)(cs)
FINAL GUARDIANSHIP REPORT
13. Ward’s Assets as of . (List all assets the ward owned individually
(date) or jointly. Attach extra pages if necessary.)
a. Cash on hand (not in an account) $
(amount) (where located)
Explain any changes since last report:
b. Burial Account
Name of Bank or Institution
Type of
Account
Account
Number
Balance
Explain any changes since last report:
c. Alaska Native Corporation Dividend Account
Name of Bank or Institution
Type of
Account
Account
Number
Balance
Explain any changes since last report:
d. List all other bank accounts, certificates of deposit, etc. Attach the most recent
bank statement. Attach additional pages if necessary.
Name of Bank or Institution
Name(s) on
Account
Account
Number
Balance
Explain any changes since last report:
e. List all Brokerage Accounts, Stocks, Bonds, and Other Securities. Attach the
most recent account statement. Attach additional pages if necessary.
Name of Company Name(s) on Account
Account Value on
(date)
Explain any changes since last report:
Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f)
AS 13.26.276 - .286, .510, .570 & 13.06.100
Page 8 of 12
PG-215 (4/17)(cs)
FINAL GUARDIANSHIP REPORT
f. Retirement Accounts.
Name of Company Beneficiary Current Value
Explain any changes since last report:
g. Life Insurance Policies (policies the ward owns).
Name of Company
Beneficiary of Life
Insurance
Face Value of
Life Insurance
Cash Value
of Life Ins.
Explain any changes since last report:
h. Real Estate that Ward Owns (land and buildings). Attach tax assessment, if
available.
(1) Does ward own a home? No Yes. Estimated Value:$
Address:
Description:
Is there a joint owner?
No Yes
Explain any changes since last report:
(2) Other Real Estate. Estimated Value: $
Address:
Description:
Is there a joint owner?
No Yes
Explain any changes since last report:
Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f)
AS 13.26.276 - .286, .510, .570 & 13.06.100
Page 9 of 12
PG-215 (4/17)(cs)
FINAL GUARDIANSHIP REPORT
i. Vehicles. (List any cars, boats, snow machines, off-road vehicles, airplanes, etc.)
Type of Vehicle Year, Make & Model Value Co-Owner
Explain any changes since last report:
j. Furniture, Appliances and Electronic Equipment exceeding $400 in Value.
Attach additional pages if necessary.
Description of Item
Approximate Age Value
Explain any changes since last report:
k. Jewelry, Gems, Precious Metals, Coin or Stamp Collections, Other
Collections, Artwork, Raw or Decorated Ivory. Attach additional pages if
necessary.
Description of Item Location Value
Explain any changes since last report:
l. Other Personal Property. (List any item that has a value over $400. Please
include any collectibles and any other items that are particularly susceptible to
theft. Give details sufficient to allow a third party to identify the item. Attach
extra pages, if necessary.)
Description of Item Location Value
Explain any changes since last report:
Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f)
AS 13.26.276 - .286, .510, .570 & 13.06.100
Page 10 of 12
PG-215 (4/17)(cs)
FINAL GUARDIANSHIP REPORT
m. Commercial Fisheries Interests (IFQs or limited entry permits). Value
Explain any changes since last report:
TOTAL ASSETS (Total value of all items in #13 a through m) $
Total Assets at End of Previous Reporting Period: $
Change in Total Assets Since Previous Reporting Period: $
14. Ward’s Liabilities as of
.
(date)
(List all debts the ward owes. Attach extra pages if necessary.)
a. Real Estate Debts.
(1) Home described in #13(h)(1). Loan balance: $
Explain any changes since last report:
(2) Property described in #13(h)(2). Description:
Loan balance: $
Explain any changes since last report:
b. Other Loans.
Lender (Name & Address) Purpose (loan type) Loan Number Balance Due
Explain any changes since last report:
c. Credit Cards.
Company (Name & Address)
Card Card Number Balance Due
Explain any changes since last report:
0.00
0.00
Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f)
AS 13.26.276 - .286, .510, .570 & 13.06.100
Page 11 of 12
PG-215 (4/17)(cs)
FINAL GUARDIANSHIP REPORT
d. Judgments/liens.
Description Balance Due
Explain any changes since last report:
e. Amounts Owed For Services.
Service
To Whom Owed Balance Due
(1) Medical Services
(2) Attorney Services
(3) Guardian Services
(4) Other
Explain any changes since last report:
TOTAL LIABILITIES (Total all items in #14 a through e): $
Total Liabilities at End of Previous Reporting Period: $
Change in Total Liabilities Since Previous Reporting Period: $
15. NET ASSETS (Subtract Total Liabilities from Total Assets):
Total Assets from 13 a - m $
Total Liabilities from 14 a - e $
Net Estate Value $
Net Assets at End of Previous Reporting Period: $
Change in Net Assets Since Previous Reporting Period: $
16. Trusts. The ward is a beneficiary of the following trusts(s) (meaning the ward has the
right to receive benefits of some kind from the trust):
Name of Trust:
Name and Address of Trustee:
If registered with the court, list trust registration no.
State
Do you know what benefits the ward is supposed to receive from the trust?
Yes No
Is the ward receiving the benefits from the trust that he/she is supposed to receive?
Yes No I do not know.
Explain any changes since last report:
0.00
0.00
Probate Rules 16(e)(1)(C), 16(e)(3) & 17(f)
AS 13.26.276 - .286, .510, .570 & 13.06.100
Page 12 of 12
PG-215 (4/17)(cs)
FINAL GUARDIANSHIP REPORT
17. Assets Released.
The ward’s assets were released as follows:
To Whom Released Authority of Person To
Asset Released Date (Name and Address) Receive This Property *
* For authority, list recipient’s role, such as former ward, new guardian, personal
representative of deceased ward’s estate, special administrator, temporary property
custodian or heir.
Oath
I do solemnly swear (or affirm) that the information given in this report is true and correct to the
best of my knowledge and belief.
Date Guardian’s Signature
Subscribed and sworn to or affirmed before me at , Alaska
on ______________________, 20____.
(SEAL) Clerk of Court, Notary Public or other person
authorized to administer oaths.
My commission expires:
I certify that on ,
I gave a copy of this report and its
attachments to:
ward
ward’s attorney or guardian ad litem (if currently representing ward):
parent or guardian with whom ward resides (if any):
ward’s conservator (if a separate conservator was appointed):
the following person(s) designated by court order:
Guardian’s Signature
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

IN THE SUPERIOR COURT FOR THE STATE OF (State of Alaska)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 29 March 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document