Form A IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN In the Matter of the Guardianship of, Case Number: ______________________________ minor child(ren) PETITION FOR APPOINTMENT OF GUARDIAN ____________________________ petitions for the appointment of guardian of the minor, (Petitioner's name) _____________________________, the minor and respectfully represents to the Court as follows: (Minor's name) 1. THAT the name, address, and age of the minor is: Name: Current Address: Age: Birth Date: 2. THAT the minor is a resident of ______________ County, Oregon, and is also physically present in the State of Oregon. 3. THAT the proposed guardian is a Linn County resident and is competent and qualified to serve as such. The proposed guardian's name and address is: Name: Contact Address: Birth Date: Phone # 4. THAT the proposed guardian has has not been convicted of a crime. If the proposed guardian has been convicted of a crime, please explain: 5. THAT the relationship of the proposed guardian to the minor is The minor has been living with the petitioner since was living with and before that he/she Page 1 of 3 Petition to Appoint Guardian of a Minor-Linn County (3/16) American LegalNet, Inc. www.FormsWorkFlow.com 6. THAT it is necessary to establish a guardianship for the following reasons: 7. THAT the minor's written consent (if the minor is over 14 years of age) is attached hereto marked "Exhibit A", and by this reference is incorporated herein. 8. THAT the name and address of the natural parent(s) of the minor are: Mother's Name Father's Name Date: of Birth: _____________________________ Date of Birth: ______________________________ Address Address 9. THAT the natural parent(s) written consent is attached hereto, marked "Exhibit B", and by this reference is incorporated herein. 10. I understand that I must inform the court if I find out about another custody proceeding concerning this minor filed in this, or another state. 11. I have have not been involved in any other court proceeding concerning custody of the minor (if so, list County, State, and case number). County: Case Number: State: 12. I know/do not know, of any person other than custody of the minor or claims to have custody or visitation rights with minor. (If so, list that person): ________________________________________. who has physical 13. THAT the minor has lived with the following person(s) for the past five years: NAME OF PERSON ADDRESS AT THAT TIME CURRENT ADDRESS (if different) 14. THAT no other court in the State of Oregon has acquired jurisdiction of this matter, and no guardian has Page 2 of 3 Petition to Appoint Guardian of a Minor-Linn County (3/16) American LegalNet, Inc. www.FormsWorkFlow.com been heretofore appointed for the minor. 15. THAT the amount of the minor's assets are: Savings Account: $Trust Fund: $ Real Property : $ Other: $ WHEREFORE, Petitioner prays for his/her appointment as guardian of the minor Dated Signature of Petitioner Print Name and Date of Birth Contact Address City/State/Zip Code Contact Telephone Page 3 of 3 Petition to Appoint Guardian of a Minor-Linn County (3/16) American LegalNet, Inc. www.FormsWorkFlow.com