Fill and Sign the Fillable Online Ice Sevis User Manual Example Based on Form

This report should be completed annually by the guardian or more often i\ f directed by the court. In the matter of First, middle, and last name , an individual with a developmental disability Do not write below this line - For court use only Date Signature of reviewer Court action to be taken 1. I, Name (type or print) , am the guardian of the individual named above, and I report for the period Date to Date . 2. Present age of the individual: Individual's date of birth: 3. The current address and telephone number of the individual are: Check here if this is a new address . 4. The individual's present living arrangement is: own home relative's home Relationship hospital or medical center guardian's home community placement home other: 5. The individual has been in the present residence since . Descriptions and addresses of every residence where the individual has lived during this reporting period and the length of stay at each residence are as follows: 6. I rate the individual's present living arrangements as excellent. average. below average. Explain if below average 7. I believe the individual is content with the living situation. unhappy with the living situation. I recommend a more suitable residence as follows: Describe 8. The individual's mental condition has remained about the same. improved. deteriorated. Describe the changes 9. The individual's physical health has remained about the same. improved. deteriorated. Describe the changes 10. The individual's social condition has remained about the same. improved. deteriorated. Describe the changes Approved, SCAO (SEE SECOND PAGE) USE NOTE: If this form is being filed in the circuit court family division, please\ enter the court name and county in the upper left-hand corner of the fo\ rm. STATE OF MICHIGAN PROBATE COURT COUNTY REPORT OF GUARDIAN ON CONDITION OF INDIVIDUAL WITH DEVELOPMENTAL DISABILITY FILE NO. PC 663 (12/17) REPORT OF GUARDIAN ON CONDITION OF INDIVIDUAL WITH DEVELOPMENTAL DISABILITY MCL 330.1631, MCR 5.409(A) PCS CODE: CDP TCS CODE: RGD File No. 11. The individual has received the following services: medical. educational. vocational. other professional services. Describe 12. My visits with and activities on behalf of the individual were: 13. I believe the individual has the following needs: 14. I have the following questions concerning the individual or my responsib\ ilities: 15. Other information requested by the court or necessary in the opinion of the guardian is as follows: 16. The guardianship should should not be continued because: 17. As guardian, I have been ordered by the court to file an annual account,\ which is attached. 18. Comments: Date Date Signature of guardian Signature of co-guardian (if applicable) Address Address City, state, zip \ Telephone no. City, state, zip \ Telephone no. Check here if this is a new address Check here if this is a new address I am the appointed standby guardian and am willing to continue to serve in the event the guardian dies, becomes unable to serve, or resigns from the guardianship. Date Signature of guardian Address City, state, zip \ Telephone no. Check here if this is a new address STATEMENT BY STANDBY GUARDIAN Report of Guardian on Condition of Individual with Developmental Disabil\ ity (12/17)