Nebraska State Court Form REQUIRED IN THE COUNTY COURT OF COUNTY, NEBRASKA In The Matter of: Case NOTICE OF NOMINATIONPursuant to Neb Ct. Rule 2476-1433.0(A) and Neb. Rev. Stat. 24730-4112, I hereby give the Date Signature(s) of Petitioner(s) Print or Type Name of Petitioner(s) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box of Petitioner(s) City/State/ZIP Code of Petitioner(s) Page 1 of 3 Notice of Nomination of the Public Guardian and Certificate of Mailing CC 16:2.89 Rev. American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF MAILING TO THE PETITIONER: You need to complete and file this form with the court showing that you mailed the Notice of Nomination of the Public Guardian to the Office of Public Guardian and to all interested persons you listed below. I, , swear or affirm, under the penalties of perjury, that on the NAME ADDRESS See attached (more names and addresses than above) Date Signature(s) of Petitioner(s) Print or Type Name of Petitioner(s) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box of Petitioner(s) City/State/ZIP Code of Petitioner(s) Phone of Petitioner(s) E-mail Address of Petitioner(s) Page 2 of 3 Notice of Nomination of the Public Guardian and Certificate of Mailing CC 16:2.89 Rev. Ward/Incapacitated Person/Protected Person Case American LegalNet, Inc. www.FormsWorkFlow.com *Interested persons are defined as:children and spouses;future heirs if the ward/incapacitated person would die without leaving a valid will (brothers andsisters who are adults, grandparents, etc.);a trustee of any trust executed by the ward/incapacitated person;if there are no individuals defined as 223interested persons224 above, include any person ororganization named as a 223devisee224 in the ward/incapacitated person222s most recent will;after death of the ward/incapacitated person, interested person also includes the personalrepresentative of a deceased ward222s/incapacitated person222s estate, the deceasedward222s/incapacitated person222s heirs in an intestate estate, and the deceased ward222s/incapacitatedperson222s devisees in a testate estate;any governmental agency paying benefits on behalf of the ward/incapacitated person; andany person designated by order of the court to be an interested person. If there are no interested persons identified for a ward/incapacitated person, the court shall appoint a guardian ad litem (Nebraska Supreme Court Rule 247 6-1449(B)). The cost of the guardian ad litem may be taken from the assets of the ward/incapacitated person. Page 3 of 3 Notice of Nomination of the Public Guardian and Certificate of Mailing CC 16:2.89 Rev. American LegalNet, Inc. www.FormsWorkFlow.com