Document Libertycountyga_doc_829c1f8f91

Personal Status Report Page 1 Probate Court of LibertyCounty NOTE: THIS FORM MUST BE TYPED OR LEGIBLY PRINTED IN BLACK INK. 1. I/We, , am/are the guardian(s) of the above-named minor, and my/our annual report on the condition of the minor is as follows: 2. Present age of minor: Date of Birth: . 3. Living Arrangements: a. Current physical address of the minor is: b. The minor’s current residence is:  own home/apartment  guardian’s home/apartment  relative’s home/apartment  hospital or other medical facility  nursing/skilled care facility  personal care/assisted living facility  other (Specify: ) c. The minor has been in the present residence since . If moved within the past year, state change(s) and reason(s) for change: d. I/We rate the minor’s current living arrangement as  excellent,  average, or  below average. If below average, please explain: e. I/We believe the minor is  content  unhappy with the current living situation. f. I/We recommend a more suitable living arrangement for the minor as follows: Do not write below this line - Court use only IN THE PROBATE COURT OF LIBERTY COUNTY STATE OF GEORGIA IN RE: , : Minor : CASE NO. : : PERSONAL STATUS REPORT , : Annual Report on Condition of Guardian(s) : Minor ---PAGE BREAK--- Personal Status Report Page 2 Probate Court of LibertyCounty 4. Physical Health a. The minor’s current general, physical condition is  excellent  good  fair  poor. b. During the past year, the ward/minor’s physical condition has  remained about the same.  improved; explain:  worsened; explain: c. During the past year, the minor received the following medical treatment (including check-ups and dental work): Date Doctor Ailment Treatment 5. Mental Health a. The minor’s current general, mental health is  excellent  good  fair  poor. b. During the past year, the ward’s/minor’s mental condition has  remained about the same.  improved; explain:  worsened; explain: c. During the past year, mental health evaluation and/or treatment by a or social worker  was  was not provided. 6. Social Activities/Services a. The minor’s current social condition is  excellent  good  fair  poor. b. During the past year, the ward’s/minor’s social condition has  remained about the same.  improved; explain:  worsened; explain: c. During the past year, the minor has participated in the following activities (explain):  recreational:  educational:  social:  occupational:  no activities available:  minor refused to participate in activities:  minor was unable to participate in activities: 7. Visits by Guardian Minor resides with me/us. a. During the past year, I/we visited personally with the minor on the following dates/ occasions: . b. The average amount of time spent on each visit was . c. The last time I/we visited with the minor was on . ---PAGE BREAK--- Personal Status Report Page 3 Probate Court of LibertyCounty 8. Activities Performed for minor a. During the past year, I/we performed the following activities/services/duties for the minor: . 9. I/We believe that the minor has the following unmet needs (if any): . 10. The guardianship  should  should not be continued because: . 11. Is the minor capable of expressing any opinions about the guardianship, the personal needs of the minor, or the services of the guardian?  Yes  No If yes, what has the ward/minor expressed about those issues? . N/A 12.  I/We also serve as conservator(s) for the ward/minor. If so, my/our accounting for the current year  is filed simultaneously with this report  was filed earlier on  is not yet due but will be filed on  has not been filed because ; OR  I/We do not serve as conservator(s) for the minor. I/We  have  have not received funds for the support, care, education, health and welfare of the minor. If so, following is a description of the amount(s) and expenditures of all such funds received by me/us during the reporting period: . My/Our current contact information is: Printed Name of Guardian Printed Name of Co-Guardian Street Address Street Address City, State, ZIP City, State, ZIP Mailing Address, if different Mailing Address, if different Home Telephone Work Telephone Home Telephone Work Telephone Electronic Mail (Email) Address Electronic Mail (Email) Address ---PAGE BREAK--- Personal Status Report Page 4 Probate Court of LibertyCounty Verification The answers to the foregoing questions and the information provided with regard to the ward/minor are true and correct to the best of my/our personal knowledge and belief and are hereby made under oath. Guardian’s Signature Co-Guardian’s Signature Printed Name of Guardian Printed Name of Co-Guardian Sworn to and subscribed before me Sworn to and subscribed before me on on Notary Public or Clerk of Probate Court Notary Public or Clerk of Probate Court ORDER ADMITTING TO RECORD The within and foregoing Personal Status Report is hereby accepted, approved and ordered admitted to record on . Filed: Judge/Clerk of Probate Court Recorded on In Minute Book Page Clerk