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Guardians Report - Oregon
| Guardians Report Form. This is a Oregon form and can be used in Guardianship Circuit Court Washington Local County . |
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IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF WASHINGTON Probate Department In the Matter of the Guardianship of ) ) ) ) ) ) No. _______________ GUARDIAN'S REPORT ____________________________, A Protected Person I am the guardian for the person named above, and I make the following report to the court as required by law: 1. 2. My name is___________________________________________________ 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: _______________________________________________________________________ _______________________________________________________________________ Page 1, Guardian's Report American LegalNet, Inc. www.USCourtForms.com 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: ___________________________________________ 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):_____________________________________________________________ _______________________________________________________________________ Page 2, Guardian's Report American LegalNet, Inc. www.USCourtForms.com 12. I made the following major decisions on behalf of the person during the past year:___________________________________________________________________ _______________________________________________________________________ 13. I believe the guardianship should or should not continue because:________ _______________________________________________________________________ _______________________________________________________________________ 14. At the time of my last report, I held the following amount of money on behalf of the person: $_________. Since my last report, 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. 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 ` Yes ` No ` No (d) I have had my driver license revoked or suspended. Page 3, Guardian's Report American LegalNet, Inc. www.USCourtForms.com 17. Since my last report, I have delegated the following powers over the protected person for the following periods of time (provide name of person powers delegated to): ____________________________________________________________ _______________________________________________________________________ Dated the _______day of _________________, 20___. _________________________________ Guardian STATE OF OREGON ) ) ss. County of ____________ ) I, _____________________________, being duly sworn, say that the above Guardian's Name statements are true. _________________________________ Guardian's Signature SUBSCRIBED AND SWORN TO before me this ______ day of _______________, 20___. _________________________________ NOTARY PUBLIC FOR OREGON/COURT CLERK My commission expires: _____________ Page 4, Guardian's Report American LegalNet, Inc. www.USCourtForms.com
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