______________________________________________________________________________
The protected person's name is ______
___________________________
Conservatorship Case # ____________
County where proceedings are pending ______________________
Conservator is ____________
Conservator's address is ____________
Attorney's name is ____________
Attorney's address is ____________
The following real property is subject to proceedings: ________
Signature ______________________
Dated ______________________
STATE OF OREGON | ) | |
) | ss. | |
County of ________ | ) |
The foregoing instrument was acknowledged before me this ___ day of ______, 2___, by ____________.
______________________
Notary Public for Oregon
My commission expires: ____________
______________________________________________________________________________
ORS 125.470