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Here is the text we could read:

REPORT OF THE GUARDIAN
OF THE MINOR

DOCKET NUMBER
(if known)

Trial Court of Massachusetts
Juvenile Court Department

DIVISION

CASE NAME

Guardianship of

ANNUAL REPORT

REPORTING PERIOD:

Address

2. Minor's Name

Mailing Address

Residence Address

1. Guardian's Name Telephone Number

Guardian's Name Telephone Number

Telephone Number

Name of Institution (if minor is institutionalized)

3. Has the minor been involved in any court case/proceeding since the last report or since your appointment
as the minor's guardian? Yes No

If yes, please explain

4. Physical health of minor

Significant changes since last report

5. Hospitalization(s) since last report

Surgical procedure(s) since last report

Medication(s) since last report

6. Mental health of minor

Psychiatric treatment(s) since last report

7. Has there been any change of living conditions of the minor since the last report?

Yes No If yes, please explain.

JV-078 (Rev. 03/20/2013)

Page 1 of 2

REPORT OF THE GUARDIAN
OF THE MINOR

CASE NAME

Guardianship of Minor

DOCKET NUMBER
(if known)

8. Has there been any change in the financial status of the minor since the last report?

Yes No Please identify the minor's assets below?

Description of Bank Accounts, Property, Social Security

Estimate Value or
Amount of Income

Total

please explain.

9. Name of present school attended by the minor

Grade Are there any special educational issues that have arisen since the last report? If so,

10. Please provide any other information related to the well-being, behaviors, and care of the minor that may
assist the Court to better assess the general welfare of the minor.

11. Have you ever been investigated for abuse or neglect? Yes No
If yes, please explain.

12. Has there been any visitation between the minor and his/her parent(s) and/or sibling(s)? If yes, please
explain.

DATE

Signed under the pains and penalties of perjury.

SIGNATURE OF GUARDIAN

SIGNATURE OF CO-GUARDIAN

READ AND NOTED

SIGNATURE OF JUSTICE

JV-078 (Rev. 03/20/2013)

Page 2 of 2

Report of the Guardian of the Minor

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Massachusetts state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.mass.gov (2023-03)
Page(s): 2
Fields(s): 62
Average fields per page: 31
Reading Level: Grade 8
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Report of the Guardian of the Minor

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02