Nebraska State Court Form ACCEPTANCE OF APPOINTMENT OF TEMPORARY CONSERVATOR BY THE PUBLIC GUARDIAN CC 16:2.229 New 11/15 REQUIRED Neb. Rev. Stat. § 30-2630.01(a); Neb. Ct. R. §§ 6-1433.02(G), 6-1443(A) IN THE COUNTY COURT OF COUNTY, NEBRASKA Case # IN THE MATTER OF Protected Person ACCEPTANCE OF APPOINTMENT OF TEMPORARY CONSERVATOR BY THE PUBLIC GUARDIAN The Public Guardian accepts the appointment as temporary conservator of the assets of, and swears that they will perform, according to law, all (protected person) duties for the protected person as temporary conservator. 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 Page 1 of 3 Acceptance of Appointment of Temporary Conservator by the Public Guardian CC 16:2.229 New 11/15 American LegalNet, Inc. www.FormsWorkFlow.com