Form K IN THE CIRCUIT COURT OF THE STATE OF OREGON IN AND FOR THE COUNTY OF MULTNOMAH In the Matter of the Guardianship of ) Case No. ) ) Minor Child ) LIMITED JUDGMENT ESTABLISHING ) GUARDIANSHIP of a MINOR ) ORS 125.305 Minor Child ) On , this matter came before the court to appoint a legal guardian for the above named child(ren). It appears to the court from the records and files herein that: 1. Venue is properly in this court of Multnomah County and no other court in this state has acquired jurisdiction in this matter. 2. A guardian is authorized to receive minor amounts of money on behalf of the child(ren) and to hold the money and apply the monies for the benefit of the child(ren). A guardian may not use the child(ren)s money to pay himself/herself for services provided to the child(ren) except for actual expenses incurred in providing food, shelter, education, etc. A legal guardian is required to file an annual report with the court within 30 days after each anniversary date of the Courts appointment of the guardianship. A guardian must promptly inform the court of any change of address. If problems arise regarding a guardians ability or willingness to continue to serve in the role of legal guardian, it is the guardians responsibility to request a hearing before the court. The child shall remain in the custody of the legal guardian and shall not be returned to the parents or placed with any person without the express approval of the court. NOW, THEREFORE, IT IS HEREBY ORDERED AND ADJUDGED; THAT: 1. is appointed legal guardian(s) for the above named child/ren effective immediately without a hearing and without requirement of a surety bond. 2. The guardian/s shall have all of the statutory powers and duties of a guardian pursuant to ORS 125. 3. Physical custody of the minor(s) is hereby awarded to the Guardian/s. 4. Legal custody of the minor(s) is hereby awarded to the Guardian/s. 5. Letters of guardianship shall be issued to . DATED , 20 Circuit Court Judge Personal Information of Person Appointed Guardian: : Name of Guardian/s Address of Guardian/s . Telephone No. Page 2 of 2 Limited Judgment Establishing Guardianship of a Minor American LegalNet, Inc. www.FormsWorkFlow.com