Free Proof of Service - 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 OF SERVICE

_______________________________________ A Protected Person. STATE OF OREGON County of Marion ) ) )

ss.

I, ________________________, guardian in this case, being first duly sworn, say that I served the attached Notice Regarding Time for Filing Objections, Motion to Allow Payment of Room and Board and supporting affidavit upon: _____________________________________ Protected Person _____________________________________ Address _____________________________________ City, State, Zip ___________________________________ Name ___________________________________ Relationship to Protected Person ___________________________________ Address ___________________________________ City, State, Zip ___________________________________ Name ___________________________________ Relationship to Protected Person ___________________________________ Address ___________________________________ City, State, Zip

_____________________________________ Name _____________________________________ Relationship to Protected Person _____________________________________ Address _____________________________________ City, State, Zip

AFFIDAVIT OF SERVICE - Page 1 of 2

FC(11/3/05)

by depositing true copies thereof in the United States mail in ______________, Oregon on __________________(date) enclosed in an envelope with first class postage to the last known address listed for each person above. Dated: ____________________ ___________________________________ Signature of Guardian

SUBSCRIBED AND SWORN to before me on this ______ day of _____________, 20___. ___________________________________ Deputy Court Administrator/Notary Public My Commission expires: ______________ Submitted by: ___________________________________ Name Bar. No. (if any) ___________________________________ Address ___________________________________ City, State, Zip ___________________________________ Telephone ___________________________________ E-mail Fax

AFFIDAVIT OF SERVICE - Page 2 of 2

FC(11/3/05)