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 GUARDIAN'S FEE

______________________________________ A Protected Person.

STATE OF OREGON

) ) County of _______________ ) I hereby swear or affirm that: 1.

ss.

I am the Guardian in this matter and have provided valuable and necessary services on

behalf of the protected person. 2. I am requesting approval of a Guardian's fee for the period of time from

________________, 20_____ to _________________, 20______. 3. I am requesting approval of a fee in the amount of $_________________. The amount

of this fee is calculated as follows: Time spent on guardianship matters during this period: Hourly rate (not to exceed $30.00 per hour): Total requested fee (not to exceed $750 first year and $350 subsequent years): 4. ___________ hours $__________ $__________

An itemization of the time I have spent on guardianship matters during the period

covered by this request is attached to this Affidavit. (Attach time itemization) AFFIDAVIT IN SUPPORT OF MOTION FOR GUARDIAN'S FEE - Page 1 of 2 FC (10/20/04)

5. 20_____. 6.

I last requested approval of a guardian's fee from the court on: _____________,

To the best of my knowledge, no funds of the protected person have been found from

which my fees could be paid. 7. My usual hourly rate for these types of matters in $__________. If billed on a "full-

fee" basis, my requested guardian fee for this case would have been in the amount of $______________. 8. I make this Affidavit in support of my Motion for Approval of a Guardian's Fee.

______________________________ Signature of Guardian

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 GUARDIAN'S FEE - Page 2 of 2

FC (10/20/04)