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JDF 834 SC R6/19 GUARDIAN’S REPORT - MINOR Page 1 of 7 ❑ District Court ❑ Denver Probate Court County, Colorado Court Address: In the Interest of : Minor COURT USE ONLY Attorney or Party W ithout Attorney (Name and Address): Phone Number: E -mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom GUARDIAN’S REPORT – MINOR Current Reporting Period From ________________T o __________________ (MM/DD/YYYY) (MM/DD/YYYY) (REPORTING DATES MUST BE FOR THE PAST YEAR AND MAY NOT REPORT INTO THE FUTURE.) Instructions to guardian: You have been ordered to c omplete a Guardian’s Report every year on behalf of the minor . When answering the questions in this report, you are required to provide details. Answers such as “same as last year” or “no change since last report” are not acceptable answers. Your report may be rejected with those answers. COLORADO LAW REQUIRES THAT ANY GUARDIAN W ANTING TO REMOVE THE MINOR CHILD FROM THE STATE OF COLORADO MUST OBTAIN COURT PERMISSION. You must file the necessary forms to make this request and obtain court permission. CONTACT INFORMATION Minor ’s Information: ❑ Check if Updated Information from last Report Name: Age : Street Address: (Include Name of Living Center or Nursing Home) City: State: Zip Code: Mailing A ddress, if different: City: ____________________ State: __________________ Zip Code: __________________ Primary Phone : Alternate P hone:____________________ Guardian ’s Information: ❑ Check if Updated Information from last Report Name: Age : Occupation: Your Relationship to Minor : Street Address: City: ____________________ State: _______________ Zip Code: _______________________ Mailing Address, if different: __________________________________________________ City: State: ______ Zip Code: _________ E -Mail Address: Primary Phone : Alternate Phone:____________________ JDF 834 SC R6/19 GUARDIAN’S REPORT - MINOR Page 2 of 7 Have you had any criminal charges filed against you or convictions entered since the last report? ❑ Yes ❑ No If Yes, explain: Co -Guardian ’s Information: (if applicable) ❑ Check if Updated Information from last Report Name: Age : Occupation: Your Relationship to Minor: Street Address : City: State: ______ Zip Code: _________ Mailing Address, if different: __________________________________________________________ City: _____________________ State: __________ Zip Code: _____________ E-Mail Address: Primary Phone : Alternate Phone:____________________ Have you had any criminal charges filed against you or convictions entered since the last report? ❑ Yes ❑ No If Yes, explain: I. STAT US INFORMATION Yes No A. Do you recommend that the guardianship continue? ❑ ❑ If No , explain: B. Do you recommend any changes to the guardianship? ❑ ❑ If Yes , explain: C. Do you wish to remain guardian? ❑ ❑ If No , explain: Note: If you wish to terminate this guardianship, or modify by replacing the current guardian or adding a co-guardian, yo u must file a separate petition with the court. D. The minor’s care and living situation is: ❑ Very Good ❑ Good ❑ Adequate ❑ Poor E. Do you believe the current plan for care is in the minor’s best interest? ❑ Yes ❑ No If No, describe your recommended changes: JDF 834 SC R6/19 GUARDIAN’S REPORT - MINOR Page 3 of 7 F. Who currently provides the majority of the minor’s supervision or care and treatment on a daily basis? Name Primary P hone: Alternate P hone: ________________________________ G. Has the minor’s residence changed since the last report? ❑ Yes ❑ No If Yes , identify the date of the move, address of residence, type of residence and reason for the change. II. PERSONAL CARE AND OT HER ISSUES A. Date of the minor’s last medical exam: Dental exam: B. Are the Minor’s immunizations current? ❑ Yes ❑ No If No , explain: C. Is the minor covered under health or dental insurance? ❑ Yes ❑ No If Yes , describe coverage. If No , explain efforts to obtain coverage. D. Describe any counseling services provided to the minor. E. Describe any other services provided to the minor. F. Describe any medical services provided to the minor. Date of Move Address of Residence Type of Residence Reason for Change JDF 834 SC R6/19 GUARDIAN’S REPORT - MINOR Page 4 of 7 G. Identify any special needs of the minor during this reporting period. H. Has the minor’s physical and medical condition changed since the last report? If Yes, explain: I. Identify any significant events involving the minor since the last report e.g. special awards or recognition. ____________________________________________________________________________________ J. Has the minor been involve d in a juvenile delinquency case or any other type of court action? ❑ Yes ❑ No If Yes , in which County? ____________________________________________ K. Does the minor have any behavioral issues? ❑ Yes ❑ No Describe the nature of the behavioral issues and any treatment the minor is receiving to help with the issues. L. If the minor child is not of school age, identify the stages of development for th e minor child. This would include but is not limited to, if the child developed his or her motor skills (crawling, walking, etc.), learned to talk, and learned colors, shapes and numbers at age appropriate times. Include if the child is on track developme ntally for his or her age and if not on track, explain why not and the steps taken to help the child. Does the child’s doctor have any concerns? JDF 834 SC R6/19 GUARDIAN’S REPORT - MINOR Page 5 of 7 M. Does the minor have any contact with the parents or other family members? ❑ Yes ❑ No Briefly describe the visits: Name of person visiting, frequency and length of visits and date of the last visit. If no visits, briefly describe why not. III. EDUCATION AND EXTRAC URRICULAR ACTIVITIES A. Is the minor attending school: ❑ Yes ❑ No If Yes, complete the information below: If No, please be sure to answer question L on page 4, Part II. Name of School : Current Grade Level: _______ Address: Phone Number: Minor’s grades are: ❑ Excellent ❑ Average ❑ Below Average If below average explain why . B. If the minor is old enough, does he or she have a job? ❑ Yes ❑ No Describe . C. Describe the educational services provided to the minor. D. Identify a few of the minor’s goals, accomplishments, and any extracurricular activities during this reporting period. JDF 834 SC R6/19 GUARDIAN’S REPORT - MINOR Page 6 of 7 IV. FINANCIAL MATTERS Complete this section only if there is no conservatorship and the guardian has custody of funds. A. Does the minor own any property ? ❑ Yes ❑ No B. Do you have possession or control of the minor’s assets , e.g. property (real estate and personal property items ), financial accounts? ❑ Yes ❑ No If Yes , describe the type of property and approximate value of the property : C. Do you have control of the minor’s Income? ❑ Yes ❑ No D. If Yes , describe: Do you or the minor receive any financial support f rom the biological parents or other family members ? ❑ Yes ❑ No If there is a current child support order, provide the name of the court , case number, date of mo st recent order, and status of the payments. Name of Court Case Number State Date of Current Order Amount Payment Status e.g. on time, late E. If applicable, identify the representative payee for Social Security and other income benefits. Name: Phone Number : F. Have any fees been paid to you in your role as guardian? ❑ Yes ❑ No If Yes , describe: G. Have any fees been paid to others for the care of the minor or his or her property? ❑ Yes ❑ No If Yes , describe: SUMMARY OF FINANCIAL ACTIVITY DURING REPORTING PER IOD Beginning balance of bank accounts (savings, checking, etc.) $ Plus mon ies received (social security, pension beneficiary , child support , interest, etc .) from any source on behalf of the person +$ Less total fees to care providers -$ Less total monies paid to the Minor , e.g. personal needs -$ Less total fees paid to guardian -$ Less any other expenses, e.g. housing, insurance, maintenance -$ Ending balance of bank accounts $ JDF 834 SC R6/19 GUARDIAN’S REPORT - MINOR Page 7 of 7 You are required to maintain supporting documentation for all receipts and all disbursements under your control during the duration of this appointment. The court or any interested persons as identified in the Order Appoint ing Guardian may request copies at any time. ❑ By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. ❑ By checking this box, I am acknowledging that I have made a change to the original content of this form. VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the ______ day of Executed on the ______ day of (date) (date) _______________________, _________, _______________________, _________, (month) (year) (month) (year) at ______________________________________ at ______________________________________ (city or other location, and state OR country) (city or other location, and state OR c ountry) _______________________________ _______________________________ (printed name) (printed name) _______________________________ _______________________________ (Signature of Guardian) (Signature of Co -Guardian, if any) ______________________________________ __________________ Attorney Signature, (if any) Date CERTIFICATE OF SERVICE I certify that on ___________________ (date), a copy of this _______________ (name of document) was served as follows on each of the following: Name and Address Relationship to Decedent, Ward, or Protected Person Manner of Service* *Insert one of the following: hand delivery, first -class mail, certified mail, e -service, or fax. _____________________________________________ Signature NOTE: If you wish to change the persons entitled to receive copies of reports or other documents filed, you must file a separate petition with the court.