Nebraska State Court Form CC 16:2.97 Rev. 11/2015 REQUEST FOR WAITING LIST ASSIGNMENT REQUIRED Neb. Ct. R. §§ 6-1433.02(2), 6-1433.01(D), 6-1433.01(J) IN THE COUNTY COURT OF ___________________COUNTY, NEBRASKA IN THE MATTER OF Case #____________________ Ward/Incapacitated Person/Protected Person REQUEST FOR WAITING LIST ASSIGNMENT The Public Guardian has filed with this court: Acknowledgement of Notice of Nomination ­ Verification of No Caseload Capacity Verification of No Caseload Capacity Subsequent to Court Visitor or Guardian ad Litem Report Having found the denial of the appointment of the Public Guardian as guardian and/or conservator is based on no caseload capacity being available, the court, Pursuant to Neb. Ct. Rule §6-1433.02(2), requests the above named individual be placed on the waiting list. DATED: , 20 BY THE COURT: County Judge PREPARED AND SUBMITTED BY: Page 1 of 1 Request for Waiting List Assignment CC 16:2.97 Rev. 11/15 American LegalNet, Inc. www.FormsWorkFlow.com