Guardians Report

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF _________________ DEPARTMENT OF PROBATE In the Guardianship of: Case No. ________________ , A Protected Person GUARDIAN'S REPORT GUARDIAN'S REPORT I am the guardian for the person named above, and I make the following report to the court as required by law: 1. My name is 2. My address and telephone number are: Phone _________________________ 3. The name, if applicable, and address of the place where the person now resides are: 4. The person is currently residing at the following type of facility or residence: Guardian's Report Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com 5. The person is currently engaged in the following programs and activities and receiving the following services (brief description): 6. I was paid for providing the following items of lodging, food or other services to the person: 7. The name of the person primarily responsible for the care of the person at the person's place of residence is: 8. The name and address of any hospital or other institution where the person is now admitted on a temporary or permanent basis are: 9. The person's physical condition is as follows (brief description): 10. The person's mental condition is as follows (brief description): 11. I made the following contacts with the person during the past year (brief description): Guardian's Report Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com 12. I made the following major decisions on behalf of the person during the past year (brief description): 13. I believe the guardianship should or should not continue because: 14. At the time of my last report, I held the following amount of money on behalf of the person: $___________. Since my last report, I received the following amount of money on behalf of the person: $____________. I spent the following amount of money on behalf of the person: $____________. I now hold the following amount of money on behalf of the person: $____________. 15. A true copy of this report will be given to the person, any conservator for the person and any other person who has requested notice. 16. Since my last report: (a) I have been convicted of the following crimes (not including traffic infractions): (b) I have filed for or received protection from creditors under the Federal Bankruptcy Code (yes or no): _____________. (c) I have had a professional or occupational license revoked or suspended (yes or no): __________. (d) I have had my driver license revoked or suspended (yes or no): ________. Guardian's Report Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com 17. Since my last report, I have delegated the following powers over the protected person for the following periods of time (provide name of person powers delegated to): Dated this ___ day of _______________, 20___. ____________________________________ Guardian's Signature ___________________________________ Guardian Printed Name STATE OF County of ) ) ss. ) I, __________________________, being first duly sworn, say that the above statements are true. ___________________________________ Guardian SUBSCRIBED AND SWORN TO before me this ____day of _____________, 20___. ________________________________ NOTARY PUBLIC FOR OREGON My commission expires: _____________ Guardian's Report Page 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF _________________ DEPARTMENT OF PROBATE In the Guardianship of: Case No. , A Protected Person ORDER RE: GUARDIAN'S REPORT After review of the Guardian's Report filed on the report is: Accepted and Acknowledged. No further action is required at this time. Not accepted; a hearing will be set to provide further information. , Dated this ___ day of _______________, 20___. ____________________________________ Circuit Court Judge Signature ____________________________________ Printed Name of Judge Guardian's Report Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com