Free Motion - Oregon

IN THE CIRCUIT COURT OF THE STATE OF OREGON THIRD JUDICIAL DISTRICT Probate Department In the Matter of the Guardianship of: ) ) ) ) ) )

Case No. MOTION TO ALLOW PAYMENT OF ROOM AND BOARD

_______________________________________ A Protected Person.

The Guardian in this matter moves the court pursuant to ORS 125.320(2) for an Order allowing reimbursement of room and board expenses incurred by the Guardian and/or the Guardian's Spouse, out of the Protected Person's estate, in the amount of $____________ per month. An affidavit in support of this motion is attached.

Dated: _____________________

_________________________________ Signature of Guardian

Submitted by: ______________________________________ Name Bar No. (if any) _______________________________________ Address _______________________________________ City, State, Zip _______________________________________ Telephone _______________________________________ E-mail Fax I certify this is a true copy: ___________________________________ Signature

MOTION TO ALLOW PAYMENT OF ROOM AND BOARD - Page 1 of 1

FC (11/3/05)