IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT PROBATE DEPARTMENT Guardianship of: ) ) ) )
Case No: ___________________ PROOF OF MAILING
______________________________ Protected Person State of Oregon ) ) ss. County of Marion)
I, __________________________, Guardian for the Protected Person named above, being first duly sworn, say as follows: A copy of the Guardian's Report was mailed on ______________, to each of the following persons or entities at their last known mailing addresses as follows: ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________
Dated this ____ day of _________________, 20_____. ______________________________ Guardian SUBSCRIBED AND SWORN to before me this ___________ day of __________, 20___. ______________________________ Notary Public for Oregon My commission expires: __________ PROOF OF MAILINGĀ Page 1 of 1
FC(11/20/08)