Alaska Documents

Alaska Documents

Homepage Alaska Guardianship Form in PDF

Example - Alaska Guardianship Form

 

 

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 #:

)

 

 

 

 

 

 

 

 

 

 

)

GUARDIANSHIP ANNUAL REPORT

Instructions

Please type or print clearly using black ink. In preparing the report, you must consult with the ward as much as possible. 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): www.state.ak.us/guardianship. 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 are a full guardian with the powers of a conservator, you must fill out the entire form. If you are a partial guardian and do not have the powers of a conservator (or if a separate conservator has been appointed), you do not need to fill out the financial information in paragraphs 10 through 16. The purpose of this report is to give the court as complete a picture as possible of the ward’s current situation and what has happened in the last 12 months.

 

 

Reporting Period

 

 

 

 

This report covers the following period: From

 

 

To

 

 

 

 

 

 

 

 

 

 

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. If you change your address, please notify the court.

Residence Address

(street address)

Do you live with the ward?

Yes

Relationship to ward:

(city) (state)

No

Page 1 of 13

Probate Rule 16(e)(1)(B), 16(e)(3) & 17(e)

PG-210 (9/08)(cs)

AS 13.26.118, .255, .380(b) & 13.06.100

GUARDIANSHIP ANNUAL REPORT

 

In what areas do you have the authority to make decisions for the ward?

housing

medical care

school & job training

employment

social & recreational activities

financial management (you control ward’s finances because you have conservator powers)

Has a separate conservator been appointed for the ward?

No

Yes Name:

If you are a private guardian charging fees, is there a court order authorizing payment of fees and establishing an hourly rate and maximum monthly amount as required by Probate Rule 16 and

AS 08.26.110?

Yes

No

I do not charge fees.

If you are a private professional guardian, do you have professional liability insurance?

Yes. (Attach copy of current Declarations page showing liability limits.) No.

 

Changes in Guardianship Needed

Is there a current need for change in the guardianship?

No

 

If yes, explain:

 

Yes

If you want the court to change its order, please file form PG-190.

If this is a Public Guardian appointment, is a suitable private guardian available?

No Yes

Information About Ward

1.Housing.

a.Where does the ward live now? Name of facility or place: Address:

 

(street address)

 

(city)

(state)

(ZIP)

 

Type of Residence:

nursing home

assisted living home

 

 

b.

Has the ward moved in the past year?

Yes

No

If yes, explain:

 

 

 

 

 

 

 

 

 

c.

If the ward lives in your home, do you charge the ward rent?

Yes

 

If you live in the ward’s home, are you paying rent?

Yes

No

d.Have you discussed the ward’s housing arrangement with the ward?

Yes. Explain what the ward wants:

No

 

No, because:

 

 

 

 

 

Page 2 of 13

Probate Rule 16(e)(1)(B), 16(e)(3) & 17(e)

PG-210 (9/08)(cs)

AS 13.26.118, .255, .380(b) & 13.06.100

GUARDIANSHIP ANNUAL REPORT

 

e.Do you plan to change the place where the ward lives?

No

Yes, to

If yes, explain why:

f.If the ward lives in a nursing home, assisted living home, group home or other

facility,

(1)Is this the least restrictive setting in which services can be provided to the

ward?

Yes

No

(2)Have you participated in developing the facility’s care plan for the ward?

Yes No.

(3)Do you believe the facility’s care plan is a good one for the ward (in the

ward’s best interests)?

Yes

No Explain:

 

 

 

 

 

 

 

 

g.Are there any problems with providing meals, clothing, house cleaning or transportation for the ward?

2.Medical Care.

a.Which of the following medical professionals has the ward seen in the past 12

months?

Doctor’s Name

Phone No. Dates Seen

Medical Doctor

Dentist

Eye Doctor

Ear Doctor

Psychologist or

Psychiatrist

Other:

b.Describe any medical problems (physical or mental) the ward has, and describe what is being done or will be done about them:

Page 3 of 13

Probate Rule 16(e)(1)(B), 16(e)(3) & 17(e)

PG-210 (9/08)(cs)

AS 13.26.118, .255, .380(b) & 13.06.100

GUARDIANSHIP ANNUAL REPORT

 

c.Describe any plans you have to change the care currently being provided for the ward’s medical problems:

d.Have you discussed these medical issues with the ward?

Yes. Explain what the ward wants:

No. Explain why not:

e.Are there any problems providing medical care or treatment for the ward?

f.Is a no-code (Do Not Resuscitate) provision in place for the ward?

Yes

No

g.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

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.

a.Does the ward attend school or any type of job training?

Yes. Describe studies (include name and location of school):

No, because:

b.Is there any type of education or training that would benefit the ward?

c. Have you discussed this with the ward? Yes. Explain what the ward wants:

No. Explain why not:

Page 4 of 13

Probate Rule 16(e)(1)(B), 16(e)(3) & 17(e)

PG-210 (9/08)(cs)

AS 13.26.118, .255, .380(b) & 13.06.100

GUARDIANSHIP ANNUAL REPORT

 

4.Work.

a. Is the ward employed?

No, because:

Yes. Describe (include type of work, name of employer, address, phone, and how long employed):

b.If not employed, would it be in the ward’s best interests to obtain employment?

c. Have you discussed this with the ward? Yes. Explain what the ward wants:

No. Explain why not:

5.Social and Recreational Activities.

a.Describe activities the ward enjoys:

b.Have you been able to help make these activities available to the ward?

c.Do you have any plans concerning additional social and recreational activities for the ward?

6.Contacts With Ward.

a.If the ward does not live with you, how often have you visited the ward in the past 12 months?

b.

Have there been any other contacts?

No

Yes, as follows:

 

Type of Contact

Frequency of Contact

by telephone

by mail or e-mail through 3rd person: other:

Page 5 of 13

Probate Rule 16(e)(1)(B), 16(e)(3) & 17(e)

PG-210 (9/08)(cs)

AS 13.26.118, .255, .380(b) & 13.06.100

GUARDIANSHIP ANNUAL REPORT

 

7.Decision Making.

a.Have there been any changes in the ward’s ability to make decisions about matters affecting the ward’s health and safety?

b.When a decision has to be made about something for the ward (housing, medical care, education, employment, recreation, purchases, etc.), how are the decisions made?

(1)Describe decisions made by ward alone:

(2)Describe decisions made by guardian alone:

(3)Describe decisions made by guardian and ward together:

8.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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.Significant Actions.

Describe any significant actions you have taken as guardian for the ward during the past

12 months:

You only have to fill out paragraphs 10 - 16 if you are a full guardian with authority to manage the ward’s finances. If you do not have financial management authority, skip to paragraph 17.

Page 6 of 13

Probate Rule 16(e)(1)(B), 16(e)(3) & 17(e)

PG-210 (9/08)(cs)

AS 13.26.118, .255, .380(b) & 13.06.100

GUARDIANSHIP ANNUAL REPORT

 

10.Ward’s Annual Income. (List only the income of the ward during the 12–month reporting period. Do not list your income.)

Income Source

Annual Amount

Income Source

Annual Amount

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 Annual Income:

 

 

 

 

 

 

 

Total Annual Income During Previous Reporting Period:

Change in Annual Income Since Previous Reporting Period

Explain any difference more than $1000:

11.Ward’s Annual Expenses. (Money paid to anyone on behalf of ward or ward’s legal dependents. Do not include your personal expenses. Attach extra pages if necessary.)

Expense

Description

 

Annual Amount

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:

 

 

 

Other (list all other payments made):

 

 

 

Total Annual Expenses:

 

 

 

 

 

 

Total Annual Expenses During Previous Reporting Period:

 

 

Page 7 of 13

Probate Rule 16(e)(1)(B), 16(e)(3) & 17(e)

PG-210 (9/08)(cs)

AS 13.26.118, .255, .380(b) & 13.06.100

GUARDIANSHIP ANNUAL REPORT

 

 

 

Change in Annual Expenses Since Previous Reporting Period Explain any difference more than $1000:

12.Money Controlled By Ward.

Does the ward have sole control over any money? If yes, please explain:

Yes

No

Is this money included in the income and expenses listed in #10 and #11? Explain:

Yes

No

13.

Ward’s Assets at the end of this Reporting Period (Date:

 

 

 

)

 

 

(List all assets the ward owns individually or jointly. Attach extra pages if necessary.)

 

 

a.

Cash on hand (not in an account) $

 

 

 

 

 

 

 

 

 

 

 

 

 

(amount)

 

(where located)

 

 

 

Explain any changes in the last 12 months:

 

 

 

 

 

 

b.

 

 

 

 

 

 

 

 

 

 

 

Burial Account

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Bank or Institution

 

Type of

 

Account

Balance

 

 

 

 

Account

 

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Explain any changes in the last 12 months:

c.Alaska Native Corporation Dividend Account

Name of Bank or Institution

Type of Account

Account Number

Balance

Explain any changes in the last 12 months:

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

Balance

Account

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 8 of 13

Probate Rule 16(e)(1)(B), 16(e)(3) & 17(e)

PG-210 (9/08)(cs)

AS 13.26.118, .255, .380(b) & 13.06.100

GUARDIANSHIP ANNUAL REPORT

 

Explain any changes in the last 12 months:

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 in the last 12 months:

f.Retirement Accounts.

Name of Company

Beneficiary

Current Value

Explain any changes in the last 12 months:

g.Ward’s 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 in the last 12 months:

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 in the last 12 months:

Page 9 of 13

Probate Rule 16(e)(1)(B), 16(e)(3) & 17(e)

PG-210 (9/08)(cs)

AS 13.26.118, .255, .380(b) & 13.06.100

GUARDIANSHIP ANNUAL REPORT

 

(2)

Other Real Estate.

 

Estimated Value: $

 

Address:

 

 

 

 

 

Description:

 

 

 

 

 

Is there a joint owner?

No

Yes

Explain any changes in the last 12 months:

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 in the last 12 months:

j.Furniture, Appliances and Electronic Equipment exceeding $400 in value. Attach additional pages if necessary.

Description of Item

 

Approximate Age

Value

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Explain any changes in the last 12 months:

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 in the last 12 months:

Page 10 of 13

Probate Rule 16(e)(1)(B), 16(e)(3) & 17(e)

PG-210 (9/08)(cs)

AS 13.26.118, .255, .380(b) & 13.06.100

GUARDIANSHIP ANNUAL REPORT

 

Your Questions, Answered

  1. What is the purpose of the Alaska Guardianship form?

    The Alaska Guardianship form is designed to provide the court with a comprehensive overview of the ward's current situation and the guardian's activities over the past year. This report helps ensure that the ward's needs are being met and that the guardian is fulfilling their responsibilities appropriately. It covers various aspects such as housing, medical care, education, and social activities.

  2. Who needs to fill out this form?

    Any guardian appointed by the court must complete this form. If you are a full guardian with conservator powers, you must fill out the entire form. However, if you are a partial guardian without conservator powers, you can skip the financial sections. It's important to consult with the ward as much as possible while preparing this report.

  3. What information is required in the form?

    The form requires detailed information about the guardian and the ward. This includes the guardian's contact information, the ward's living situation, medical care received, educational or job training status, and social activities. Additionally, the form asks about any changes in guardianship and whether the guardian has discussed these matters with the ward.

  4. What should I do if I need help completing the form?

    If you find it challenging to complete the form on your own, assistance is available. You can visit the Office of Public Advocacy's website for resources or contact them directly. Local libraries and courts may also have helpful materials. Don’t hesitate to reach out for help to ensure the form is filled out correctly.

  5. Is the information in the form confidential?

    Yes, the information provided in the Alaska Guardianship form is treated as confidential by the court. This means that personal details about the ward and the guardian will not be disclosed to the public. However, the court will review this information to ensure that the ward's best interests are being served.

Dos and Don'ts

When filling out the Alaska Guardianship form, it is crucial to follow specific guidelines to ensure accuracy and compliance with legal requirements. Here are six important dos and don'ts to consider:

  • Do type or print clearly using black ink. This helps ensure that your information is legible and correctly interpreted.
  • Don't leave any sections blank. If a question does not apply, indicate that by writing "N/A" to avoid confusion.
  • Do consult with the ward as much as possible when preparing the report. Their input is valuable and may provide essential context.
  • Don't forget to sign the form under oath or affirmation in front of a notary public or court clerk. This step is necessary to validate the document.
  • Do notify the court of any changes in your mailing address promptly. Keeping your contact information current is vital for communication.
  • Don't submit the form without reviewing it for errors. Double-checking your responses can prevent delays or complications in the guardianship process.

Similar forms

The Alaska Guardianship form shares similarities with the Durable Power of Attorney (DPOA) document. Both serve to protect individuals who may be unable to make decisions for themselves. While the guardianship form is typically used when a court appoints a guardian to oversee a person's welfare, the DPOA allows a person to designate someone else to make decisions on their behalf while they are still capable. Both documents emphasize the importance of ensuring that the appointed individual acts in the best interest of the person they represent, whether it be for health care, finances, or personal matters.

Another document akin to the Alaska Guardianship form is the Conservatorship Agreement. Like guardianship, conservatorship is a legal arrangement where a person is appointed to manage the financial affairs of someone who is unable to do so. The key difference lies in the focus; conservatorship primarily addresses financial matters, while guardianship encompasses broader aspects of personal care and welfare. Both require a court's approval and involve ongoing reporting to the court regarding the well-being and financial status of the individual under protection.

For those looking to secure their living arrangements, a well-structured Room Rental Agreement is essential in defining the roles and responsibilities of both the landlord and tenant. Understanding how this form works can greatly assist in avoiding potential disputes. You can find a customizable format of this vital document at our useful Room Rental Agreement resource.

The Health Care Proxy is another document that resembles the Alaska Guardianship form. This legal tool allows individuals to appoint someone to make medical decisions on their behalf if they become incapacitated. Similar to guardianship, it ensures that a trusted person can advocate for the individual's health care preferences. However, the Health Care Proxy is limited strictly to medical decisions, whereas guardianship can encompass a wider range of responsibilities, including personal and financial matters.

Finally, the Advance Health Care Directive (AHCD) is comparable to the Alaska Guardianship form in that it outlines an individual’s wishes regarding medical treatment in situations where they cannot communicate their preferences. Both documents aim to safeguard the individual's rights and ensure that their needs are met according to their wishes. However, while the AHCD focuses on specific medical decisions, guardianship encompasses a broader spectrum of care and support, often requiring ongoing oversight and reporting to a court.

How to Write Alaska Guardianship

Filling out the Alaska Guardianship form requires careful attention to detail. Each section asks for specific information about the ward and the guardian. After completing the form, you will need to sign it in front of a notary public or court clerk. Make sure to keep a copy for your records.

  1. Begin by entering the name of the court and the case number at the top of the form.
  2. Fill in the name of the ward and their date of birth.
  3. Provide the residential location of the ward, including the full address.
  4. List the ward's telephone number.
  5. Type or print your name as the guardian, along with your daytime phone number and mailing address.
  6. Indicate if your mailing address has changed by checking the appropriate box.
  7. Provide your residence address and state whether you live with the ward.
  8. Specify your relationship to the ward.
  9. Indicate which areas you have the authority to make decisions for the ward, such as housing, medical care, and finances.
  10. State if a separate conservator has been appointed for the ward and provide their name if applicable.
  11. If you charge fees as a private guardian, indicate if there is a court order authorizing your fees.
  12. Answer whether there is a current need for change in the guardianship.
  13. For the ward’s housing, provide the name and address of the facility or place where the ward lives.
  14. Indicate if the ward has moved in the past year and explain if applicable.
  15. Discuss the ward's housing arrangement and whether you charge rent.
  16. Answer questions about the ward's medical care, including any medical professionals they have seen.
  17. Describe any medical problems the ward has and the plans for their care.
  18. Provide information about the ward's education or job training status.
  19. Discuss the ward's employment situation and any potential for future employment.
  20. List the social and recreational activities the ward enjoys and your involvement in facilitating these activities.
  21. Detail how often you have visited the ward and any other forms of contact in the past year.
  22. After completing all sections, sign the form in front of a notary public or court clerk.

Documents used along the form

When navigating the guardianship process in Alaska, several additional forms and documents may be required alongside the Alaska Guardianship form. Understanding these documents can help ensure that the guardianship is established and maintained in accordance with legal requirements. Below is a list of commonly used forms and documents in this context.

  • Guardianship Petition: This document initiates the guardianship process. It outlines the reasons for seeking guardianship and provides information about the proposed guardian and the ward.
  • Notice of Hearing: This form informs interested parties of the upcoming court hearing regarding the guardianship petition. It ensures that all relevant individuals have the opportunity to attend and participate.
  • Order Appointing Guardian: If the court approves the guardianship petition, this order officially appoints the guardian and outlines their responsibilities and powers.
  • FedEx Bill of Lading: A vital document for shipping goods through FedEx Freight services, providing necessary details and terms for clear communication; for more information, visit TopTemplates.info.
  • Guardianship Plan: This document details the proposed plan for the ward’s care and management. It covers aspects such as living arrangements, medical care, and financial management.
  • Annual Report of Guardian: This report provides an update on the ward’s situation and the guardian’s activities over the past year. It is essential for maintaining transparency with the court.
  • Financial Inventory: If the guardian has conservatorship powers, this form lists the ward’s assets and liabilities. It provides a clear financial picture for the court.
  • Medical Authorization Form: This document grants the guardian the authority to make medical decisions on behalf of the ward, ensuring that healthcare providers recognize the guardian's role.
  • Consent for Services: This form allows the guardian to consent to various services on behalf of the ward, such as medical treatments, educational programs, or social services.
  • Termination of Guardianship: If the guardianship is no longer necessary, this form is used to request the court to terminate the guardianship, outlining the reasons for this request.

Familiarity with these forms and documents can streamline the guardianship process and help ensure that the ward’s needs are met effectively. It is always advisable to seek assistance or guidance when filling out these forms to ensure compliance with legal standards and requirements.

Misconceptions

Misconceptions about the Alaska Guardianship form can lead to confusion and mismanagement. Here are nine common misconceptions clarified:

  1. The form is only for full guardians. Many believe that only full guardians need to complete the form. However, partial guardians also have responsibilities and must provide relevant information about the ward's situation.
  2. Confidentiality is not guaranteed. Some individuals think that the information shared in the form is not confidential. In reality, the court treats all information in the report as confidential.
  3. Assistance is not available. There is a misconception that individuals must complete the form without help. The Office of Public Advocacy offers resources and assistance for those who may need it.
  4. Financial information is required for all guardians. Many assume that all guardians must fill out financial sections of the form. In truth, partial guardians without conservator powers do not need to provide this information.
  5. Changes in guardianship are not necessary. Some believe that once a guardianship is established, it cannot be changed. However, if circumstances change, guardians can request modifications through the appropriate court forms.
  6. Medical decisions are solely the guardian's responsibility. It is a common belief that guardians have complete authority over medical decisions. While they do have significant authority, the wishes of the ward should be considered and discussed.
  7. Guardianship is permanent. Many think that guardianship lasts indefinitely. Guardianship can be temporary or subject to review, depending on the ward's changing needs.
  8. Ward's preferences do not matter. Some individuals believe that the ward's opinions and preferences are irrelevant. In fact, the form emphasizes the importance of consulting with the ward about their wishes.
  9. All guardians charge fees. There is a misconception that all guardians are compensated for their services. Many guardians, especially family members, do not charge fees, and the form accommodates this situation.

Common mistakes

  1. Incomplete Information: Failing to provide all required details, such as the ward's name, date of birth, or residential address, can lead to delays in processing the form.

  2. Not Consulting the Ward: The instructions emphasize the importance of discussing the report with the ward. Ignoring this step can result in inaccuracies in the information provided.

  3. Incorrect Signatures: The form must be signed under oath in front of a notary public or court clerk. Not following this requirement can invalidate the report.

  4. Failure to Update Address: If the guardian's mailing address changes, it is crucial to notify the court. Neglecting to do so may lead to missed communications.

  5. Omitting Financial Information: Partial guardians must avoid filling out financial details unless they have conservator powers. However, full guardians must complete all sections, including financial information.