Jackson Supp. L. R. 16 app E

As amended through June 11, 2024

Appendix E - Guardian's Report for Minor

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY

In the Matter of the Guardianship of:
	CASE NO. _______________________
____________________________	GUARDIAN'S REPORT FOR MINOR
Name of the protected person

Minor's Date of Birth: ________________

1. The address of the minor is:

___________________________________________________________

______________________________ Telephone: ___________________

2. Is the minor living with you? YES ______ NO _______

If not, please state who the child is living with, the relationship of that person to the child, and why the child stopped living with you:

_____________________________________________________________

When did the child leave your residence?

_______________________________

3. How is the minor doing in school? Is he/she participating in any extracurricular activities?

_____________________________________________________________

4. I believe I ___ should or ___ should not continue to be the guardian for the minor child because:

_____________________________________________________________

5. Any additional information you wish to provide to the court regarding this minor's adjustment to your care:

_____________________________________________________________

6. During the past year, I have received $__________from ____________________to help support this minor. I spent $_________ of that income on behalf of the minor and now I have $________remaining.

7. Since my last report:

(a) I have been convicted of the following crimes (not including traffic infractions):__________________________________________________________

(b) I have filed for or received protection from creditors under the Federal Bankruptcy Code: ____ Yes ____ No

(d) I have had my driver's license revoked or suspended:_____Yes _____ No

I am the guardian herein and 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.

________________

Date

___________________________

Signature of Guardian

________________

Date

___________________________

Signature of Co-Guardian (if applicable )

_________________________________________________________________

FOR COURT USE ONLY:

APPROVED BY:_________________________

Appendix E (Per SLR 9.162(3))

Jackson Supp. L. R. 16 app E

Amended effective 2/1/2024.