Nebraska State Court Form REQUIRED ACCEPTANCE OF APPOINTMENT OF TEMPORARY CONSERVATOR CC 16:2.219 New 11/15 Neb. Rev. Stat. § 30-2630.01(a) and Neb. Ct. R. § 6-1443(A) IN THE COUNTY COURT OF COUNTY, NEBRASKA Case # IN THE MATTER OF Protected Person ACCEPTANCE OF APPOINTMENT OF TEMPORARY CONSERVATOR I, (Name of conservator(s)) , accept appointment as temporary conservator of the assets of _______________________________, and swear that I will perform, according to law, all duties for (Protected person) the protected person as temporary conservator. Date Signature(s) of Conservator(s) Print or Type Name of Conservator(s) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box of Conservator(s) City/State/ZIP Code of Conservator(s) Phone of Conservator(s) E-mail Address of Conservator(s) Page 1 of 1 Acceptance of Appointment of Temporary Conservator CC 16:2.219 New 11/15 American LegalNet, Inc. www.FormsWorkFlow.com