Conservator'S Report - Oregon Circuit Court Page 2

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IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF MARION
PROBATE DEPARTMENT
Conservatorship of:
)
Case No.: ______________________
)
)
PROOF OF MAILING
)
Protected Person
)
I,________________________, Conservator for the Protected Person named above declare as follows:
(Conservator’s name)
A copy of the Conservator’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)
(agency)
Guardian (if one)
(interested party)
Co-Conservator (if one)
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________.
Conservator(s)
Proof of Mailing
9/24/12

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