Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Custodians Report Form. This is a Oregon form and can be use in Polk Local County.
Loading PDF...
Tags: Custodians Report, Oregon Local County, Polk
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
:
IN THE CIRCUIT COURT FOR THE STATE OF OREGONSUBPOENA
JUDICIAL
Plaintiff(s)
FOR THE COUNTY OF POLK
-against-
:
In the Matter of the Protective Proceeding for
)
:
)
Case No.________________
:
________________________________________ )
)
CUSTODIAN’S REPORT
Defendant(s)
:
A.minor,. Protected.Person.. . . . . . . . . . . . . . . . . . . . . . . ) . . . .
.... ..... ........ ......
.
I am the custodian of funds for the child named above, and I make the following report to
the court:
THE PEOPLE OF THE STATE OF NEW YORK
1.
TO My name, address and telephone number are:_______________________________________
___________________________________________________________________________
__________________________________________Phone:______________________________
GREETINGS:
2. The address where the child lives is:______________________________________________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend
___________________________________________________________________________ before
,
the Honorable
at the
Court
located at
County of my last report I have:
3. Since
in room a. Been ,convicted ofday of
on the
, 20
, at
o'clock in the
noon, “ none.
the following crime(s):___________________________/and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
b. Received protection under federal bankruptcy laws: “yes / “ no.
c. Had a job-related license revoked or suspended: “ yes / “ no.
d. Had my driver’s license revoked or suspended: “ yes / “ no.
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoenaof theissued recent statement of each account that holds the
4. Attached to this report is a copy was most for a maximum penalty of $50 and all damages sustained as a
resultchild’s funds . to comply.
of your failure
Witness, Honorable
Court in
County,
STATE OF OREGON )
) ss
County of Polk
)
day of
, one of the Justices of the
_________________________________________
, 20
Custodian
(Attorney must sign above and type name below)
I, _____________________________________, (Custodian’s name), being first duly
Attorney(s) for
sworn, say that the above statements are true.
_________________________________________
Office and Custodian
P.O. Address
Subscribed and sworn to before me on _____day of ______________________, 20____.
Telephone No.:
_________________________________________
Facsimile No.:
Notary Public for Oregon
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
