______________________________________________________________________________

IN THE _________ COURT ____________ COUNTY,

STATE OF OREGON

DEPARTMENT OF PROBATE

In the Matter of the ) No. ______

Guardianship of )

____________, )

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:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

(2) If the guardian indicates in the report under subsection (1) of this section that the guardianship should not continue or fails to provide adequate information in the report supporting the continuing need for the guardianship, the court shall order the guardian to supplement the report or file a motion to terminate the protective proceeding under ORS 125.090.

(3) Failure of the guardian to comply with an order under subsection (2) of this section before the 30th day following the date of the order is grounds for removal under ORS 125.225 (1).

(4) If the guardian fails to comply with an order issued under subsection (2) of this section, the court, on its own motion or on the petition of any other person, shall order the guardian to appear and show cause why the guardian should not be removed.

(5) The court shall serve a copy of any order issued under subsection (2) or (4) of this section and a copy of the report filed under subsection (1) of this section and supplemental materials, if any, upon those persons entitled to notice under ORS 125.060 (3). [1995 c.664 §32; 1997 c.717 §6; 2007 c.284 §4; 2013 c.218 §16; 2017 c.391 §6; 2019 c.77 §3; 2019 c.198 §6]