1. 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

2. APS 180 GUARDIANSHIP REPORTING FORM(Rev. 11-03) Page 2 of 1