The Oregon Annual Report Guardian form serves as a crucial document for guardians overseeing the well-being of protected adults or minors. This form requires guardians to provide a comprehensive update on the individual's living situation, health status, and any significant decisions made on their behalf over the past year. By completing this report, guardians fulfill their legal obligations and ensure that the needs of the protected person are being met appropriately.
The Oregon Annual Report Guardian form plays a crucial role in the guardianship process, ensuring that the well-being of protected individuals—whether adults or minors—is closely monitored and documented. This form is required by law, specifically ORS 125.325, and must be completed annually by guardians to provide a comprehensive overview of the protected person's status. It includes essential information such as the names and contact details of all guardians involved, the current residence of the protected individual, and insights into their physical and mental health conditions. Additionally, the form requires guardians to outline any significant decisions made on behalf of the protected person, as well as their engagement in various programs and activities. Financial accountability is also a key component; guardians must report on any funds held for the protected individual, detailing income received and expenditures made. The form not only serves as a record of the guardian's responsibilities but also as a means to ensure transparency and accountability in the guardianship arrangement. By filing this report, guardians affirm their commitment to the well-being of those they care for, while also adhering to legal requirements that safeguard the rights of protected individuals.
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF CLACKAMAS
Probate Department
In the Matter of the Guardianship of
)
Case No. P__________________
ANNUAL REPORT OF GUARDIAN
FOR PERIOD ENDING:
(Enter name of Protected Adult or Minor)
(End date)
Birth Date of Protected Person: _______________
(Note on completing form: Please answer each question every year; add additional sheets if necessary. Do not leave any blanks, and do not duplicate completed form from prior years.)
I/we are the guardian(s) for the person named above and make the following report as required by ORS 125.325. (Note: a separate report must be filed for each protected person.)
1.Name(s) of all guardians: (Note: all guardians must sign report.)
_________________________________________
2.Contact information for each guardian:
Name: ________________________ Phone: _______________ Email: ____________________
Address: ______________________________________________________________________
3.The name (if applicable) and address of the place where the protected person now resides is:
______________________________________________________________________________
4.The protected person is currently residing at the following type of facility or residence:
5.The name of the individual primarily responsible for the care of the protected person at the protected person=s place of residence is:
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6.The name and address of any hospital or other institution where protected person is now admitted or has been admitted (on a temporary or permanent basis) is:
7.Please describe the protected person’s physical condition:
8.Please describe the protected person’s mental condition:
9.Please describe the contacts you made with the protected person during the past year:
10.Please describe major decisions made on the protected person's behalf during the past year:
11.The protected person is currently engaged in the following programs and activities and receiving the following services (brief description):
12.Since my last report, I have delegated the following powers over the protected person for the following periods of time:
Name of Person:
__________________________________________________________
Powers delegated:
Period(s) of time:
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13.I was paid for providing the following items of lodging, food or other services to the protected person: _______________________________________________________________________
14.
Should the guardianship continue? (Circle one) YES NO Describe why, or why not:
15.At the time of my last report, I held the following amount of money on behalf of the protected person: $__________________
Since my last report, I received the following amount of money on behalf of the person:
$__________________. The source of this money was _________________________________
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:
16.I HEREBY CERTIFY THAT SINCE MY LAST REPORT:
A.I have been convicted of the following crimes (not including traffic infractions):
(If none, so state) _________________________________________________________
B.I have filed for or received protection from creditors under the Federal Bankruptcy code: No _______ If Yes, Bankruptcy Case No. and brief explanation:
________________________________________________________________________
C.I have had a professional or occupational license revoked or suspended:
No ___ If Yes, explain: ____________________________________________________
D.I have had my driver=s license revoked or suspended:
I HEREBY CERTIFY THAT A TRUE COPY OF THIS REPORT HAS BEEN GIVEN OR MAILED TO THE PROTECTED PERSON OR MINOR (IF 14 YEARS OF AGE OR OLDER).
I FURTHER CERTIFY THAT A TRUE COPY OF THIS REPORT HAS BEEN GIVEN TO ANY CONSERVATOR FOR THE PERSON AND TO ALL INDIVIDUALS WHO ARE ENTITLED TO NOTICE, OR WHO HAVE REQUESTED NOTICE, AS FOLLOWS:
PERSON
By Personal Service or by Mail at:
Date served/mailed
_______________________________
___________________________
_______________
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I hereby declare that the above report 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: __________________
__________________________________________________
SIGNATURE OF GUARDIAN
SIGNATURE OF CO-GUARDIAN
APPROVED this _______ day of _________________, 20___.
_____Judge of the Circuit Court
_____Probate Coordinator
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