M.S. 524.5-111 State of Minnesota District Court Probate Division Judicial District: ____________ Court File No. ______________ Case Type: 14,_____________________ County of _____________ In Re: Guardianship Conservatorship of ________________________________ Acceptance of Appointment By: Individual Professional Individual Corporation BY INDIVIDUAL: I, (name), the appointed Guardian, Conservator, of the above named ward or protected person, accept my appointment and will fully and faithfully perform all the duties of such office according to law. I submit to the jurisdiction of the Court in any proceeding relating to this ward or protected person that may be instituted by the court or any person interested in the affairs of the ward or protected person. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated: ___________________, 20___ Signature Name: Address: City/State/Zip: Telephone: E-mail address: BY CORPORATION: (“Corporation”) is a corporation under the Laws of the State of Minnesota. As a condition to receiving letters as Guardian, Conservator, the Corporation (1) accepts the duties of such office, (2) agrees to be bound by Minnesota law relating to guardians and conservators, and (3) submits to the jurisdiction of the Court in any proceeding relating to this ward or protected person that may be instituted by the court or any person interested in the affairs of the ward or protected person. The Corporation has authorized this acceptance to be signed in the corporate name. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated: GAC 1-U , 20___ State ENG Rev 7/15 BY: ITS: Address: City/State/Zip: Telephone: E-mail address: www.mncourts.gov/forms Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com