Guardian'S Report - Oregon Circuit Court (Page 3 of 3) in pdf

Guardian'S Report - Oregon Circuit Court Page 3

IN THE CIRCUIT COURT OF THE STATE OF OREGON

FOR THE COUNTY OF MARION

PROBATE DEPARTMENT

Guardianship of:

)

Case No: ___________________

)

______________________________

)

PROOF OF MAILING

Protected Person

I, __________________________, Guardian for the Protected Person named above declare as follows:

(Guardian or Co-Guardian’s name)

A copy of the Guardian’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)

______________________________________

__________________________________

______________________________________

__________________________________

______________________________________

__________________________________

Conservator (if one)

(interested party)

______________________________________

__________________________________

______________________________________

__________________________________

______________________________________

__________________________________

Co-Guardian (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_____.

______________________________

Guardian(s)

Proof of Mailing

9/24/12

Guardian'S Report - Oregon Circuit Court Page 3

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