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Guardians Report - Oregon
| Guardians Report Form. This is a Oregon form and can be used in Circuit Court Jackson Local County . |
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IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY ) ) ________________________________________, ) (Name of protected person) ) A protected person ) ________________________________________ ) In the matter of the Guardianship of CASE NO:_______________ GUARDIAN'S REPORT I am the guardian for the person named above, and I make the following report to the court as required by law: 1. My name is:________________________________________________________________ 2. My address and telephone number are: _________________________________________________________________________ _______________________________________________________Phone_______________ 3. The name, if applicable, and address of the place where the person now resides are: ________________________________________________________________________ _________________________________________________________________________ 4. The person is currently residing at the following type of facility or residence: ________________________________________________________________________ 5. The person is currently engaged in the following programs and activities and receiving the following services (brief description): _________________________________________________________________________ _________________________________________________________________________ 6. I was paid for providing the following items of lodging, food, or other services to the person: __________________________________________________________________________ 7. The name of the person primarily responsible for the care of the person at the person's place of residence is: _________________________________________________________________________ GUARDIAN'S REPORT Page 1 of 3 6/16/09 American LegalNet, Inc. www.FormsWorkFlow.com 8. The name and address of any hospital or other institution where the person is now admitted on a temporary or permanent basis are: _________________________________________________________________________ _________________________________________________________________________ 9. The person's physical condition is as follows (brief description): _________________________________________________________________________ _________________________________________________________________________ 10. The person's mental condition is as follows (brief description): ________________________________________________________________________ ________________________________________________________________________ 11. I made the following contacts with the person during the past year (brief description): _________________________________________________________________________ _________________________________________________________________________ 12. I made the following major decisions on behalf of the person during the past year (brief description): _________________________________________________________________________ _________________________________________________________________________ 13. I believe the guardianship should or should not continue because: _________________________________________________________________________ _________________________________________________________________________ 14. I received the following amount of money on behalf of the person: $_______________. I spent the following amount of money on behalf of the person: $______________. I now hold the following amount of money on behalf of the person: $_______________ 15. A true copy of this report will be given to the person, any conservator for the person and any other person who has requested notice. GUARDIAN'S REPORT Page 2 of 3 6/16/09 American LegalNet, Inc. www.FormsWorkFlow.com 16. Since my last report: (a) I have been convicted of the following crimes (not including traffic infractions): ________________________________________________________________________ (b) I have filed for or received protection from creditors under the Federal Bankruptcy Code: ______ yes ______no (c) I have had a professional or occupational license revoked or suspended: ______ yes _______no (d) I have had my driver's license revoked or suspended: ______ yes ______ no 17. Since my last report, I have delegated the following powers over the protected person for the following periods of time (provide the name(s) of person(s) powers were delegated to): ________________________________________________________________________ I am the guardian herein and I hereby declare that the above statement is true to the best of my knowledge and belief. I understand that it is made for use as evidence in court and is subject to penalty for perjury. DATED this _____________ day of ___________________________, __________. ___________________________________ Guardian's Signature ___________________________________ Print Name __________________________________ Guardian's Address: __________________________________ __________________________________ Phone No: GUARDIAN'S REPORT PAGE 3 of 3 6/16/09 American LegalNet, Inc. www.FormsWorkFlow.com
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