Free Guardian's Report - Oregon

IN THE CIRCUIT COURT OF THE STATE OF OREGON THIRD JUDICIAL DISTRICT Probate Department In the Matter of the Guardianship of: ) ) ) ) ) )

Case No. GUARDIAN'S REPORT

______________________________________ A Minor, 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 is: My telephone number is: The name, if applicable, and address of the place where the person now resides are:

3.

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: The name and address of any hospital or other institution where the person is now admitted on a temporary or permanent basis are:

8.

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9.

The person's physical condition is as follows:

10.

The person's mental condition is as follows:

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): I believe the guardianship should should not continue because:

13.

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 have 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: $ . 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. Since my last report: (A) I have been convicted of the following crimes (not including traffic violations): none (B) I have filed for or received protections 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 license revoked or suspended: yes / no 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):

15.

16.

17.

I hereby declare that the above statement is true to the best of my knowledge and belief, and that I understand it is made for use as evidence in court and is subject to penalty for perjury.

Dated this

day of

, 200

.

Guardian

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