IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY ) In the Matter of the Conservatorship of ) ) ) ____________________________________ ) Adult/Minor/Protected Person ) CASE NO._______________ CONSERVATOR'S ANNUAL ACCOUNTING Pursuant to ORS 126.283(1), the undersigned, the duly appointed, qualified and acting conservator of the above named adult/minor or protected person, reports to the Court as follows: 1. My name is:__________________________________________________ 2. My residence address and telephone number are:_____________________ ____________________________________________________________ 3. The name and address of the place where the minor and/or protected person now resides is:________________________________________________ ____________________________________________________________ 4. This accounting is for the period of:_______________________________ 5. What is the total value of the estate:______________________________ 6. The dollar amount and source of all income and property received, and expenditures made during the period of this accounting: SOURCE OF INCOME: ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ EXPENDITURES MADE AND TO WHOM: ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Conservator's Annual Accounting Page 1 of 2 AMOUNT $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ 12/1/16 American LegalNet, Inc. www.FormsWorkFlow.com 7. A list of the money and other property which the minor and/or protected person now owns, including any items of money or property which I hold for the minor and/or protected person, and the estimated dollar value of each of the items is as follows: MONEY/PROPERTY DOLLAR VALUE/LOCATION TRANSACTIONS MADE ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ I am the conservator herein and I hereby declare that the above statement is true to the best of my knowledge and belief. I understand that it is made for use as evidence in court and is subject to penalty for perjury. Dated:_______________________ ____________________________ Conservator's signature ____________________________ Print name ____________________________ Address: ____________________________ ____________________________ Phone No. Conservator's Annual Accounting Page 2 of 2 12/1/16 American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY In The Matter of the Conservatorship of Case No. (Name of Protected Person) , A Protected Person ORDER APPROVING CONSERVATORSHIP'S ANNUAL ACCOUNTING The Conservatorship's annual accounting is hereby: Approved Denied and this case shall be set for a show cause hearing. _________________________________ Certificate of Readiness This proposed order is ready for judicial signature because this order is being submitted after proper notice to interested parties has been given and no objections have been filed. ________________________________________ __________________ Signature Date ________________________________________ Print Name ________________________________________ Address (or contact address) ________________________________________ City, State, Zip Telephone Order Approving Conservatorship's Accounting.docx Page 1 of 1 1/09/2017 American LegalNet, Inc. www.FormsWorkFlow.com