Oregon Revised Statutes Chapter 125 § 125.325 — Guardian’s report

Guardian’s report. (1) Not later than 30 days following each anniversary of appointment, a guardian for an adult protected person shall file with the court a written report. The report must include a declaration under penalty of perjury in the form required by ORCP 1 E, or an unsworn declaration under ORS 194.800 to 194.835, if the declarant is physically outside the boundaries of the United States. Copies of the guardian’s report must be given to those persons specified in ORS 125.060 (3). Except as provided in subsection (6) of this section, the report must be in substantially the following form: ______________________________________________________________________________ IN THE _________ COURT ____________ COUNTY, STATE OF OREGON DEPARTMENT OF PROBATE In the Matter of the                 )           No. ______ Guardianship of                      ) ____________,                       ) (Name of protected                 ) person)                                                ) A Protected                             ) Person.                                     ) 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: ______________________ 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. Facts that support the conclusion that the person is incapacitated include the following: ______________________ 12. I made the following contacts with the person during the past year (brief description): ______________________ 13. I limited the person’s association with _____ (Please specifically name any limitations and briefly describe the limitation): ______________________ 14. I made the following major decisions on behalf of the person during the past year (brief description): ______________________ 15. I believe the guardianship should or should not continue because: ______________________ 16. 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: $______. 17. 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. 18. Since my last report: (a) I have been convicted of the following crimes (not including traffic violations): ______________________ (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): _____. 19. 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): ______________________ I hereby declare that the above statement is true to the best of my knowledge and belief, and that I understand it is made for use as evidence in court and is subject to penalty for perjury. Dated this ___ day of ________, 2___. ______________________ Guardian NOTICE: ANY PERSON INTERESTED IN THE AFFAIRS OR WELFARE OF THE PROTECTED PERSON WHO IS THE SUBJECT OF THIS REPORT WHO HAS CONCERNS ABOUT THIS REPORT OR THE GUARDIAN’S PERFORMANCE MAY CONTACT THE COURT AS FOLLOWS: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____________