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Custodians Report Form. This is a Oregon form and can be use in Marion Local County.
Tags: Custodians Report, Oregon Local County, Marion
IN THE CIRCUIT COURT OF THE STATE OF OREGON
THIRD JUDICIAL DISTRICT
In the Matter of the Protective Proceeding for:
A Minor, Protected Person.
I am the custodian of funds for the child named above, and I make the following report to the court:
My name, address and telephone number are:
The address where the child lives is:
Since my last report I have:
a. Been convicted of the following crimes:
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.
Attached to this report is a copy of the most recent statement of each account that holds the child’s
I hereby declare that the above statement is true to the best of my knowledge and belief, and that I
understand it is made for use as evidence in court and is subject to penalty for perjury.
Dated this _________ day of ________________________, 20__________.
CUSTODIAN’S REPORT - Page 1 of 1
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