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Guardians Report Form. This is a Oregon form and can be use in Josephine Local County.
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: . Guardian Report Page 1 of 3 American LegalNet, Inc. www.USCourtForms.com 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). Guardian Report Page 2 of 3 American LegalNet, Inc. www.USCourtForms.com 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: Guardian Report Page 3 of 3 American LegalNet, Inc. www.USCourtForms.com