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WITH DEVELOPMENTAL DISABILITY This report should be completed annually by the guardian or more often if directed by the court. In the matter of 1. I, , an individual with a developmental disability First, middle, and last name , am the guardian of the individual named above, and I report for Name (type or print) the period to Date 2. Present age of the individual: . Date Individual's date of birth: 3. The current address and telephone number of the individual are: . C.

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