GUARDIANSHIP REPORTING FORM

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					                                  GUARDIANSHIP REPORTING FORM


NEW GUARDIANSHIP:


Date of Guardianship:

Name of Ward:

Legal County:

Supervising County:

Ward’s Address/Location:

Type of Facility or Living Arrangement:

Guardian of Property, if any describe:

Petitioner:

Social Security Number:

Date of Birth:


   CHANGE IN WARD’S CIRCUMSTANCES:

                                    Address/Location; Describe

                                    Other; Describe


   TERMINATION OF DFCS GUARDIANSHIP; DATE:

                                  Ward Died; Cause of Death
                                  Restoration of Rights
                                  Successor Guardian Appointed; specify:


Please send this Information to: Department of Family and Children Services, DHR
                                 Adult Protective Services/ Protective Services Unit
                                 Two Peachtree Street, 18th Floor
                                 Atlanta, GA 30303

                                Fax: 404 657-3486




APS 180 GUARDIANSHIP REPORTING FORM (Rev. 11-03)                                       Page 1 of 1

				
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