PETITIONER222S/GUARDIAN PETITIONER222S MOTION AND AFFIDAVIT IN SUPPORT OF DISMISSAL Page 1 of 2 (EPPDAPA 8/2016) IN THE CIRCUIT COURT OF THE STATE OF OREGON COUNTY OF (See CIF) ) Petitioner (date of birth) ) (name of person to be protected) ) PETITIONER222S/ GUARDIAN PETITIONER222S ) MOTION AND AFFIDAVIT IN SUPPORT by and through his/her Guardian Petitioner: ) OF DISMISSAL ) (Elderly Persons and Persons With Disabilities (name of Guardian Petitioner) ) Abuse Prevention Act) ) v. ) Case No. (See CIF) ) Respondent (date of birth) ) (person to be restrained) ) MOTION AND AFFIDAVIT Comes the Petitioner Guardian Petitioner, , and moves court for an order allowing the voluntary withdrawal and dismissal of the Restraining Order to Prevent Abuse of Elderly Person or Person with Disabilities on file herein based on the following: Signature of Petitioner Print or type name of Petitioner STATE OF OREGON ) ) County of ) This instrument was acknowledged before me this day of , 20 by (Print Name of Petitioner) NOTARY PUBLIC FOR OREGON/COURT CLERK My commission expires: American LegalNet, Inc. www.FormsWorkFlow.com PETITIONER222S/GUARDIAN PETITIONER222S MOTION AND AFFIDAVIT IN SUPPORT OF DISMISSAL Page 2 of 2 (EPPDAPA 8/2016) Certificate of Document Preparation You are required to truthfully complete this certificate regarding the document you are filing with the court. Check all boxes and complete all blanks that apply: I selected this document for myself and I completed it without paid assistance. I paid or will pay money to for assistance in preparing this form. Petitioner222s/Guardian Petitioner222s Signature Print Name Address City, State, Zip Telephone/Contact Telephone Use safe contact address Use safe contact number American LegalNet, Inc. www.FormsWorkFlow.com