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Guardians Report Form. This is a Oregon form and can be use in Josephine Local County.
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Tags: Guardians Report, Oregon Local County, Josephine
IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JOSEPHINE COUNTY
In the Matter of the Guardianship of
)
) Case No.
)
)
)
)
(Name of Protected person)
A Protected Person
GUARDIAN’S REPORT
I am the guardian for the person named above, and I make the following report to
the court as required by law: (If additional space is needed, please write on a separate
piece of paper and attach)
1.
My name is
.
2.
My address and telephone number are:
.
Phone:
3.
The name, if applicable, and address of the place where the person now resides
are:
.
4.
The person is currently residing at the following type of facility or residence:
.
5.
The person is currently engaged in the following programs and activities and
receiving the following services (brief description):
.
6.
I was paid for providing the following items of lodging, food or other services to the
person:
.
7.
The name of the person primarily responsible for the care of the person at the
person’s place of residence is:
.
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8.
The name and address of any hospital or other institution where the person is now
admitted on a temporary or permanent basis are:
.
9.
The person’s physical condition is as follows (brief description):
.
10.
The person’s mental condition is as follows (brief description):
.
11.
I made the following contacts with the person during the past year (brief
description):
.
12.
I made the following major decisions on behalf of the person during the past year
(brief description):
.
13.
I believe the guardianship should or should not continue because:
.
14.
At the time of my last report, I held the following amount of money on behalf of the
person: $
. Since my last report, I received the following amount of
money on behalf of the person: $
money on behalf of the person: $
. I now hold the following amount of
money on behalf of the person: $
15.
. I spent the following amount of
.
A true copy of this report will be given to the person, any conservator for the person
and any other person who has requested notice.
16.
Since my last report:
a.
I have been convicted of the following crimes (not including traffic
violations).
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b.
I have filed for or received protection from creditors under the Federal
Bankruptcy Code (yes or no):
c.
I have had a professional or occupational license revoked or suspended
(yes or no):
d.
17.
.
.
I have had my driver license revoked or suspended (yes or no):
.
Since my last report, I have delegated the following powers over the protected
person for the following periods of time (provide name of person powers delegated
to):
Dated this
day of
20
.
Guardian
STATE OF OREGON
)
)
County of Josephine
ss.
)
I,
(Guardian’s name), being first duly sworn, say
that the above statements are true.
(Guardian’s Signature)
SUBSCRIBED AND SWORN TO BEFORE ME this
day of
, 20
.
Notary Public for the State of Oregon
My Commission expires:
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