Fillable Mpc443 Annual Report Of Guardian Of Minor Fill (Commonwealth of Massachusetts)

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Mpc443 Annual Report Of Guardian Of Minor Fill (Commonwealth of Massachusetts)

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MPC 443 (5/30/11) RPTAGM
of
page
ANNUAL REPORT OF
GUARDIAN OF MINOR
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court
Docket No.
In the Interests of:
Last Name
Middle Name
Minor
Division
Child's name, date of birth and address:
(Address)
(Apt, Unit, No. etc.)
(State)
(Zip)
Last Name
Middle Name
First Name
(Date of Birth)
Each guardian's name and address:
(Zip)
(State)
(Apt, Unit, No. etc.)
(Address)
Last Name
M.I.
First Name
1.
Please list the names, ages and relationship to you of all persons currently living in your household:
First Name
M.I.
Last Name
Age
Relationship
2.
Have you been investigated for abuse or neglect since the last report or since you were in court?
Yes
No
If YES, please state the date(s), circumstances, investigating agency, outcome and any information regarding court
involvement such as the name of the court and docket number of the case:
3.
Has the child moved since your last report or since you were last in court?
If YES, please explain:
Yes
No
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MPC 443 (5/30/11) RPTAGM
of
page
4.
Is the child currently in school?
If NO, and the child is over age 6, please explain:
Yes
No
If YES, please answer the following:
What grade is the child in?
How is the child doing in school? Please describe the child's grades and any special services the child is receiving in
school:
5.
Has the child's physical, psychological or medical condition changed since the last report?
Has he/she been hospitalized or injured?
If YES, please explain:
Yes
No
6.
Does the child have contact with his or her parent(s)?
If YES, how frequently, how recently, is it regular, and what is the quality of the contact?
Yes
No
7.
Has the child been involved in any court cases since the last report or since you were
last in court? For example - delinquency or criminal charges, CHINS petition?
If YES, please explain:
Yes
No
8.
Please provide any other information you believe will assist the court in reviewing the child's general well being. (Attach
additional pages if needed)
MPC 443 (5/30/11) RPTAGM
of
page
SIGNED UNDER THE PENALTIES OF PERJURY
I affirm or swear under oath that I have read the foregoing petition and that the statements set forth therein are true and correct
to the best of my knowledge.
Signature of Guardian
Date
Signature of Co-Guardian (if applicable)
Date
BBO No.:
Primary Phone #:
(Address)
(Apt, Unit, No. etc.)
(City/Town)
(State)
(Zip)
Print Name
Attorney for Guardian:
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Mpc443 Annual Report Of Guardian Of Minor Fill (Commonwealth of Massachusetts)

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Completed 28 July 2020

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