Page 1 of 3 -- Petition for Appointment of Guardian of a Minor (12/2015) Form A IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF MULTNOMAH Probate Department In the Matter of the Guardianship of Case No. PETITION FOR APPOINTMENT OF , GUARDIAN OF MINOR A Minor. (ORS 21.145) , A Minor. I am the Petitioner, the person asking for appointment of a guardian. Name: Contact Address: City/State/Zip: Age and Year of Birth: 2. This minor is a resident of County, Oregon, and is also physically present in the State of Oregon. 3. The proposed guardian is a Multnomah County resident and is competent and qualified to serve as guardian. Name: Contact Address: City/State/Zip: Age and Year of Birth: 4. The proposed guardian has American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 -- Petition for Appointment of Guardian of a Minor (12/2015) 5. The proposed guardian (Explain the relationship) 6. The minor .( Explain the relationship). The minor has been living here for (how long). Before that, the minor lived with , Explain the relationship) 7. A guardianship is necessary for the following reasons: 8. The name and address of the natural parent(s) are: Mother deceased Father deceased Name: Contact Address: City/State/Zip: 9. The written consent is attached hereto, and is a part of my petition.. tached hereto, and is a part of my petition.. 10. I understand that I must inform the court if I find out about another custody proceeding concerning this minor filed anywhere in Oregon or in another state or country. 11. I have have not been involved in any other court proceedings concerning custody of this minor. If you have been involved in any other court proceedings about this minor, fill out the information below. County State Case # Type of Case American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 -- Petition for Appointment of Guardian of a Minor (12/2015) 12. I know do not know of any person other than who has physical custody of the minor or claims to have custody or visitation rights with the minor. (List any other person you know who has or claims rights to this minor: . 13. R Dates From/To County & State where Minor (s) lived Name of Parent or other Caretaker during that time Current Address or Contact Address of that Parent or Caretaker . 14. No other court in Oregon has acquired jurisdiction of this matter. No guardian has already been appointed for the minor. 15. I believe the $ in Savings Account $ in Trust Fund County $ from Real Prope rty $ from another source ( & n ame source) I am asking for appointment of the guardian named above I hereby declare that the above statements are true to the best of my knowledge and belief. I understand that these statements are made for use as evidence in court and are subject to penalty for perjury. x x Co - Printed Name Date Signed: Address/Contact Address City/State/Zip Phone # or Contact # American LegalNet, Inc. www.FormsWorkFlow.com