Free Affidavit - Oregon

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

Case No. AFFIDAVIT IN SUPPORT OF MOTION FOR APPROVAL OF VISITOR'S FEE

______________________________________ Respondent. STATE OF OREGON ) ) County of _______________ ) I hereby swear or affirm that: 1. 2.

ss.

I am the court appointed Visitor in this matter. I have prepared and submitted my report to the court. I am requesting approval of a

fee in the amount of $____________. The amount of this fee is calculated as follows: Time spent on report: Hourly rate (not to exceed $30.00 per hour): Total requested fee (not to exceed $150.00): 3. ___________ hours $__________ $__________

An itemization of the time I have spent preparing my report is attached to this

Affidavit. (Attach time itemization) 4. My usual hourly rate for these types of matters is $____________. If billed on a

"full-fee" basis, my requested visitor fee for this case would have been in the amount of $______________.

AFFIDAVIT IN SUPPORT OF MOTION FOR VISITOR'S FEE - Page 1 of 2

FC (10/20/04)

5.

I make this Affidavit in support of my Motion for Approval of Visitor's Fee. ______________________________ Signature of Visitor

SUBSCRIBED AND SWORN TO before me this _______day of ________________, 20______. _______________________________ Clerk/Notary/Judge My Commission Expires: __________

Submitted by: ______________________________________ Name Bar No. (if any) _______________________________________ Address _______________________________________ City, State, Zip _______________________________________ Telephone _______________________________________ E-mail Fax

AFFIDAVIT IN SUPPORT OF MOTION FOR VISITOR'S FEE - Page 2 of 2

FC (10/20/04)