IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Protective Proceeding of ) ) ) ) ) ) ) Protected Person. , CASE NO. ACCEPTANCE OF APPOINTMENT AS TEMPORARY CONSERVATOR AND ACKNOWLEDGEMENT OF DUTIES I, conservator of the protected person named above. , accept the duties of temporary I have read the powers and duties of a conservator in AS 13.26.500 through 13.26.575, and I understand them. I understand that I am being granted only the powers set forth in the court's order appointing me temporary conservator. I solemnly swear to perform the duties set forth in my appointment order. I understand that I must complete at least one hour of education on the basics of conservatorship and file the PG-120 Affirmation form with the court within 30 days after my appointment. I further understand that I must file any reports the court asks me to file and notify the court of any change in my address and the address of the protected person. I understand that my temporary appointment will end when a long-term conservator or full guardian is appointed for the protected person or when the petition for a long-term conservator or full guardian is dismissed. Date Temporary Conservator's Signature Mailing Address City Home Phone State Work Phone ZIP Cell Phone Verification I state on oath or affirm that I have read the above Acceptance and that all statements made in it are true to the best of my knowledge and belief. Date Temporary Conservator's Signature Subscribed and sworn to or affirmed before me at , Alaska on . Date (SEAL) Clerk of Court, Notary Public, or other person authorized to administer oaths. My commission expires: PG-437 (2/17)(cs) ACCEPTANCE OF APPOINTMENT AS TEMPORARY CONSERVATOR American LegalNet, Inc. www.FormsWorkFlow.com Probate Rule 17(c) AS 13.26.480