IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT____________________ In the Matter of the Protective Proceeding of ) ) ) ) ) ) ) Protected Person. , CASE NO. ACCEPTANCE OF APPOINTMENT AS CONSERVATOR AND ACKNOWLEDGEMENT OF DUTIES I, , accept the duties of conservator of the protected person named above. I solemnly swear to perform the duties of conservator according to the law. I have read the powers and duties of a conservator in AS 13.26.500 through 13.26.575, and I understand them. I also understand any restrictions on these powers imposed by the court. I further understand that I must file (1) an Implementation Report within 90 days after the date the court distributes my appointment order, (2) an Annual Report every year until the conservatorship ends, and (3) a Final Report when my service as conservator ends. I understand that I must complete at least one hour of education on the basics of conservatorship and file the PG-120 Affirmation form with the court within 30 days after my appointment. Date Conservator's Signature Mailing Address City Verification State Daytime Telephone ZIP I state on oath or affirm that I have read the above Acceptance and that all statements made in it are true to the best of my knowledge and belief. Date Subscribed and sworn to or affirmed before me at on . Date (SEAL) Conservator's Signature , Alaska Clerk of Court, Notary Public, or other person authorized to administer oaths. My commission expires: Probate Rule 17(c) AS 13.26.480 PG-435 (2/17)(cs) ACCEPTANCE OF APPOINTMENT AS CONSERVATOR American LegalNet, Inc. www.FormsWorkFlow.com