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Custodians Report - Oregon

Custodians Report Form. This is a Oregon form and can be used in Probate Circuit Court Polk Local County .
 Fillable pdf Last Modified 9/25/2014
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IN THE CIRCUIT COURT FOR THE STATE OF OREGON FOR THE COUNTY OF POLK In the Matter of the Protective Proceeding for ________________________________________ A minor, Protected Person. ) ) ) ) ) Case No.________________ CUSTODIAN'S REPORT I am the custodian of funds for the child named above, and I make the following report to the court: 1. My name, address and telephone number are:_______________________________________ ___________________________________________________________________________ __________________________________________Phone:______________________________ 2. The address where the child lives is:______________________________________________ ___________________________________________________________________________ 3. Since my last report I have: a. Been convicted of the following crime(s):___________________________/ " none. b. Received protection under federal bankruptcy laws: "yes / " no. c. Had a job-related license revoked or suspended: " yes / " no. d. Had my driver's license revoked or suspended: " yes / " no. 4. Attached to this report is a copy of the most recent statement of each account that holds the child's funds . _________________________________________ Custodian STATE OF OREGON ) ) ss County of Polk ) I, _____________________________________, (Custodian's name), being first duly sworn, say that the above statements are true. _________________________________________ Custodian Subscribed and sworn to before me on _____day of ______________________, 20____. _________________________________________ Notary Public for Oregon American LegalNet, Inc. www.FormsWorkFlow.com
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