IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF MARION PROBATE DEPARTMENT Guardianship of: ) ) ) ) Case No: ___________________ PROOF OF MAILING ______________________________ Protected Person I, __________________________, Guardian for the Protected Person named above declare as follows: (Guardian or Co-Guardian's name) A copy of the Guardian's Report was mailed on ______________, to each of the following persons or entities at their last known mailing addresses as follows: ______________________________________ ______________________________________ ______________________________________ Protected Person (Over 14) ______________________________________ ______________________________________ ______________________________________ Conservator (if one) ______________________________________ ______________________________________ ______________________________________ Co-Guardian (if one) __________________________________ __________________________________ __________________________________ (agency) __________________________________ __________________________________ __________________________________ (interested party) __________________________________ __________________________________ __________________________________ Other (if one) 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 this ____ day of _________________, 20_____. ______________________________ Guardian(s) Proof of Mailing 9/24/12