District Court Denver Probate Court _________________________________ County, Colorado Court Address: In the Interests of: Respondent/Minor Attorney or Party Without Attorney (Name and Address): Phone Number: FAX Number: Email: Atty Reg. #: COURT USE ONLY Case Number: Division: Courtroom: ACCEPTANCE OF OFFICE - GUARDIANSHIPS AND CONSERVATORSHIPS 1. I, ___________________________________________________ (full name) accept appointment to, and agree to perform the duties and discharge the trust of, the office of: Check all that apply. Guardian. Emergency Guardian. Conservator. Special Conservator. 2. I submit personally to the jurisdiction of this Court in any proceeding relating to this matter. 3. A legible copy of my driver’s license, passport or other government-issued identification is filed/e-filed as a separate document. 4. I would like to ask that the Court waive the required background information, because I, the proposed guardian/conservator am: (If this paragraph applies, check all boxes below that apply, skip questions 5 through 9, and sign in the presence of a Notary Public or Court Clerk.) A public administrator. A trust company. A bank. A credit union, savings and loan, or other financial institution. A state or county agency. A parent who resides with his or her child and who is nominated as a guardian and/or conservator of his or her child. Good cause exists to waive such disclosures for the following reasons:___________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ The Court may require a nominee to obtain additional background information that the court considers necessary to assist it in determining the fitness of the nominee for the appointment sought. Such information may include requiring a nominee to obtain fingerprint-based criminal history record checks through the Colorado Bureau of Investigation and the Federal Bureau of Investigation at the nominee’s expense. §15-14-110(5), C.R.S. 5. I have been have not been convicted of, pled no contest to, or received a deferred sentence for one or more felonies or misdemeanors. If so, describe all: Name of State and Court JDF 805 3/08 ACCEPTANCE OF OFFICE Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com 6. I have have not had a temporary or permanent civil restraining/protection order issued against me. If so, describe all: Name of State and Court Issuing Order 7. A civil (money) judgment has been has not been entered against me. If so, describe all: Name of State and Court Entering Judgment 8. I have been have not been relieved from one or more court-appointed responsibilities. If so, describe all: Name of State and Court Relieving Nominee 9. True copies of my name-based criminal history record check obtained through the Colorado Bureau of Investigation and my current credit report are filed/e-filed as separate documents. (See Instructions below.) Note: Social security numbers should not be attached or written down on this Acceptance of Office. Being duly sworn, I verify, under penalty of perjury, that the facts set forth in this Acceptance of Office and attached documentation are accurate and complete to the best of my knowledge and belief. ___________________________________________ Date: Signature of Proposed Guardian/Conservator ___________________________________________ Print Name of Proposed Guardian/Conservator ___________________________________________ Address ___________________________________________ City, State Zip Code ___________________________________________ (Area Code) Home Telephone Number Subscribed and affirmed, or sworn to before me in the County of ______________________, State of ______________, this _______ day of __________________, 20 _____. My Commission Expires: ____________________ ______________________________________ Notary Public/Clerk INSTRUCTIONS: 1. 2. 3. To obtain a name-based criminal history check from the Colorado Bureau of Investigation (CBI), contact CBI at 690 Kipling Street Denver, CO 80215, (303) 239-4300, or at www.cbi.state.co.us and click on CBI Records Check. To obtain a current credit report, contact any of the following credit reporting agencies: a. Equifax, Inc., P.O. Box 740241, Atlanta, GA 30374, 1-800-685-1111, or at www.equifax.com b. Experian, P.O. Box 2002, Allen, TX 75013, 1-888-397-3742, or at www.experian.com c. TransUnion, P.O. Box 2000, Chester, PA 19022, 1-800-916-8800, or at www.transunion.com §15-14-110, C.R.S., requires that the costs for all criminal history checks and credit reports be paid by the proposed guardian/conservator. JDF 805 3/08 ACCEPTANCE OF OFFICE Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com