Free Acceptance as Guardian - Oregon

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

Case No. ACCEPTANCE OF APPOINTMENT AS GUARDIAN

_______________________________________ Respondent.

I, __________________________________________, am nominated to serve as Guardian in this matter. If appointed, I will accept said appointment and will fulfill the legal duties and obligations of that position. I understand that this matter has or will be approved for payment from the Marion County Indigent Guardianship Fund. I have familiarized myself with the current fee guidelines of the Fund and agree to accept compensation from the Fund on that basis. I have have not ever been convicted of a crime. I have have not ever filed for or received protection under the bankruptcy laws. I have have not had a professional or occupational license revoked or cancelled that was required by the laws of any State for the practice of a profession or occupation. Dated: __________________________ ___________________________________ Signature of Nominated Guardian ___________________________________ Print/Type Name of Nominated Guardian

Submitted by: ______________________________________ Name Bar No. (if any) _______________________________________ Address _______________________________________ City, State, Zip _______________________________________ Telephone _______________________________________ E-mail Fax ACCEPTANCE OF APPOINTMENT AS GUARDIAN - Page 1 of 1 FC (10/20/04)