Form SDS0471 "Notice of Potential Default, Foreclosure or Eviction on Property Used by the Adult Foster Home Licensee" - Oregon

What Is Form SDS0471?

This is a legal form that was released by the Oregon Department of Human Services - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2019;
  • The latest edition provided by the Oregon Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SDS0471 by clicking the link below or browse more documents and templates provided by the Oregon Department of Human Services.

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Download Form SDS0471 "Notice of Potential Default, Foreclosure or Eviction on Property Used by the Adult Foster Home Licensee" - Oregon

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Safety, Oversight and Oversight Unit
Notice of Potential Default, Foreclosure or Eviction
on Property Used by the Adult Foster Home Licensee
OAR 411-050-0740
The Adult Foster Home (AFH) licensee must provide written notification
to the local AFH licensing authority within 10 calendar days’ receipt of
any notice of default or potential default, including any eviction notices,
for any property occupied or used by the licensee. Complete this form and
submit it with the attachments as indicated to notify and update the local AFH
licensing authority.
Name of licensee:
Address of security interest (property at risk):
Street
City
State
ZIP
Initial notification to the local licensing authority
(attach a copy of the written notice).
• Describe the action threatened.
• Describe the action demanded.
Page 1 of 2
DHS 0471 (08/19)
Clear Form
Print
Safety, Oversight and Oversight Unit
Notice of Potential Default, Foreclosure or Eviction
on Property Used by the Adult Foster Home Licensee
OAR 411-050-0740
The Adult Foster Home (AFH) licensee must provide written notification
to the local AFH licensing authority within 10 calendar days’ receipt of
any notice of default or potential default, including any eviction notices,
for any property occupied or used by the licensee. Complete this form and
submit it with the attachments as indicated to notify and update the local AFH
licensing authority.
Name of licensee:
Address of security interest (property at risk):
Street
City
State
ZIP
Initial notification to the local licensing authority
(attach a copy of the written notice).
• Describe the action threatened.
• Describe the action demanded.
Page 1 of 2
DHS 0471 (08/19)
Update (required at least every 30 days until the issue of default
or eviction has been resolved).
• Attach updated notices.
Not applicable
• Describe the current status.
• Describe any new action threatened or demanded by the holder of the
security interest.
Not applicable
• Provide any other information as reasonably requested by the local
licensing authority.
Not applicable
Final resolution (If the subject default property is licensed as an adult
foster home, the licensee must provide written notification to the local
licensing authority and the adult foster home residents and their
representatives, if any, within 24 hours in the following circumstances):
• Litigation is filed regarding the licensee’s security interest, including
bankruptcy petitions and evictions;
• Entry of judgment in the litigation;
• Forty days prior to any sale of the security interest occupied or used
by the licensee;
• The sale of the security interest occupied or used by the licensee.
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SDS 0471 (08/19)
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