Nebraska State Court Form REQUIRED ACCEPTANCE OF APPOINTMENT OF GUARDIAN AND CONSERVATOR BY THE PUBLIC GUARDIAN CC 16:2.216 Rev. 08/16 Neb. Ct. R. § 6-1443(A) IN THE COUNTY COURT OF IN THE MATTER OF Case # COUNTY, NEBRASKA Ward/Incapacitated Person/Protected Person ACCEPTANCE OF APPOINTMENT OF GUARDIAN AND CONSERVATOR BY THE PUBLIC GUARDIAN The Public Guardian accepts the appointment as guardian and conservator of the assets of, and swears that they will perform, according to law, all ward/incapacitated person/protected person duties as guardian and conservator. The Public Guardian acknowledges the responsibilities as guardian and conservator by initialing all of the following: Acknowledgements before Letters are issued to establish the Public Guardian's authority to serve as guardian and conservator: The Public Guardian shall file with the court an Address Information for Guardianships/ Conservatorships form (CC 16:2.5). ________ The General Information Form, unless waived by the court for good cause shown. __ The Public Guardian shall file with the court the Public Guardian Notice of Designation of Deputy Public Guardian and Associate Public Guardians form (CC 16:2.96). __ The Public Guardian shall file with the court an updated Public Guardian Notice of Designation of Deputy Public Guardian and Associate Public Guardians form (CC 16:2.96) if the designation changes after the initial filing. If funds are restricted by court order, within ten days of appointment, the Public Guardian shall file with the court, a Proof of Restricted Account form (CC 16:2.11) and (confidential) Personal and Financial Information for Guardianships and Conservatorships form (CC 16:2.23) with full account numbers. Within 30 days of appointment, the Public Guardian shall file with the court, an Acknowledgement of Financial Institution form (CC 16:2.6) showing they gave copies of the order appointing them conservator, to all financial institutions where the protected person has accounts. They shall also file a (confidential) Personal and Financial Information for Guardianships and Conservatorships Page 1 of 3 Acceptance of Appointment of Guardian and Conservator by the Public Guardian CC 16:2.216 Rev. 08/16 American LegalNet, Inc. www.FormsWorkFlow.com form (CC 16:2.23) with full account numbers and printouts of all assets and account numbers. Within 30 days of appointment, the Public Guardian shall file with the court a Budget that pursuant to Neb. Ct. Rule § 6-1433.02(D) is for informational purposes only, and the Inventory, Affidavit of Due Diligence, and Certificate of Mailing form (CC 16:2.9) of the ward's/incapacitated person's assets. Acknowledgements after Letters are issued: The Public Guardian shall file with the court an Acknowledgement of Financial Institution form (CC 16:2.6) showing that a copy of the Letters was given to all financial institutions where the ward/incapacitated person/protected person has accounts. They shall also file with the court a (confidential) Personal and Financial Information for Guardianships and Conservatorships form (CC 16:2.23) with full account numbers and printouts of all assets and account numbers. The Public Guardian shall file the Letters of Guardianship and Conservatorship with the Register of Deeds in any county where the ward/incapacitated person/protected person has real property or an interest in real property. One year after the appointment and every year thereafter, the Public Guardian shall file with the court: 1. Annual Report of Guardian on Condition of Ward form (CC 16:2.14). 2. Updated Inventory form (CC 16:2.45). 3. Annual Accounting. 4. Certificate of Proof of Possession form (CC 16:2.13). If any funds are restricted, the bank or depository must indicate a restriction to the account on the certificate: "No withdrawals without court order." 5. Copies of all individual ledger statements and/or brokerage statements for the dates covered by the accounting. If full account numbers, social security numbers, dates of birth or other personal information appear on the accounting statements and/or brokerage statements, all but the last four digits shall be blacked out before sending them to the interested persons. 6. Personal and Financial Information for Guardianships and Conservatorships form (CC 16:2.23) showing complete account numbers, etc. listed on Inventory and Certificate of Proof of Possession. This form contains confidential information and is not shared with the parties except by court order. Page 2 of 3 Acceptance of Appointment of Guardian and Conservator by the Public Guardian CC 16:2.216 Rev. 08/16 American LegalNet, Inc. www.FormsWorkFlow.com The Public Guardian acknowledges all of the documents, except the Personal and Financial Information for Guardianships and Conservatorships form, shall be sent to all interested persons along with Notice of Right to Object form (CC 16:2.16). The Public Guardian acknowledges that a Certificate of Mailing (CC 16:2.24) shall be filed with the court showing all of the documents to all interested persons have been mailed by first class mail, postage pre-paid. The Public Guardian shall notify the court of the change of address of the ward/incapacitated person/protected person within three days of the change. The Public Guardian shall not move the ward/incapacitated person/protected person to a location outside of the State of Nebraska without court permission. The Public Guardian shall notify the court of the ward's/incapacitated person's/protected person's death within three days. The Public Guardian shall file with the court a Notice of Newly Discovered Assets form (CC 16:2.18) within 30 days after becoming aware of any additional assets, gifts, awards, settlements or inheritances over $500.00 not disclosed in the most current inventory. The Office of Public Guardian is prohibited from making ATM withdrawals or receiving cash back on debit transactions. Date Signature Print or Type Name Bar Number and Firm Name (attorneys only) Street Address/P.O. Box City/State/ZIP Code Phone of E-mail Address Acceptance of Appointment of Guardian and Conservator by the Public Guardian CC 16:2.216 Rev. 08/16 American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3