Nebraska State Court Form REQUIRED ACCEPTANCE OF APPOINTMENT OF GUARDIAN BY THE PUBLIC GUARDIAN CC 16:2.211 IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF Case Ward/Incapacitated Person The Public Guardian accepts appointment as guardian of Name of ward/incapacitated person and swears they will perform, according to law, all duties as guardian. The Public Guardian acknowledges the responsibilities as guardian by initialingAcknowledgements before Letters are issued to establish the Public Guardian222s authority to serve as guardian: 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 Notice of Designation of Deputy Public 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 the guardian to all financialinstitutions whereWithin 30 days of appointment, the Public Guardian shall file with the court a Budget that pursuant to Neb. Ct. R 247 6-1433.02(D)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 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com The Public Guardian shall not move the ward/incapacitated person to a location outside of the State of Nebraska without court permission. Page 2 of 3 The Public Guardian shall file the Letters Appointing the Public Guardian as Guardian with the Register of Deeds in any county where the ward/incapacitated person has real property or an interest in real property. One year after appointment and every year thereafter, the Public Guardian shall file with the court: 1.Annual Report of Guardian on Condition of Ward (CC 16:2.14).2.Updated Inventory (CC 16:2.45).And, if the Public Guardian has possession of the ward222s/incapacitated person222s assets: 3.Annual Accounting4.Certificate of Proof of Possession (CC 16:2.13 ). If any funds are restricted, the bank ordepository must indicate a restriction to the account on the certificate showing 223No withdrawalswithout court order.224 5. Copies of all statements and/or brokerage statements for the dates coveredbythe accounting. If full account numbers, social security numbers, dates of birth or otherpersonal information appear on the accounting statements and/or brokerage statements, allbut 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 the Inventory and Certificate of Proof ofPossession (CC 16:2.13). This form contains confidential information and is not shared with theparties except by court order. 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 sent by first class mail, postage pre-paid. The Public Guardian shall notify the court of the change of address of the ward/incapacitated person within three days of the change. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 Acceptance of Appointment of Guardian by the Public Guardian CC 16:2.211 The Public Guardian shall notify the court of the ward222s/incapacitated person222s death within three days. The Public Guardian shall file with the court a Notice of Newly Discovered Asset 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. Signature Date Print or Type Name Bar Number and Firm Name (attorneys only) Street Address/P.O. Box City/State/ZIP Code Phone E-mail Address American LegalNet, Inc. www.FormsWorkFlow.com