JDF 8 76 SC R 6 /1 9 PETITION FOR APPOINTMENT OF CONSERVATOR FOR ADULT Page 1 of 8 District Court Denver Probate Court County, Colorado Court Address: In the Interest of: Respondent COURT USE ONLY Attorney or Party Without Attorney (name and address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION FOR APPOINTMENT OF CONSERVATOR FOR ADULT 1. No court proceeding is pending in this state or elsewhere concerning the respondent. The following proceeding(s) concern(s) the respondent. Identify name of court, case number, state, date, and type of proceeding if any. Name of Court Case Number State Date of Proceeding Type of Proceeding 2. The p etitioner is : a person who would be a d versely affected by lack of effective management of the r and business. a person who is interested in the estate, financial affairs, or welfare of the r espondent . the r espondent . This is a p etition for appointment of a : Permanent C onservator . Special C onservator . While a petition to establish a conservatorship is pending, there is a need to preserve and apply the property of the r espondent as may be required for the support of the r espondent or individuals who are in fact dependent upon the r espondent . ( 247 1 5 - 14 - 406( 6 ), C.R.S.) Special C onservator . There is a need for a protective arrangement or other single transaction . A permanent conservatorship is not requested. ( 247 1 5 - 14 - 412(3), C.R.S.) 3. Information about the p etitioner: Name: List all names used (also known as, formerly known as, etc .): Relationship to Respondent: Street Address: City: State: Zip Code: Mailing address, if different: City: State: Zip Code: American LegalNet, Inc. www.FormsWorkFlow.com JDF 8 76 SC R 6 /1 9 PETITION FOR APPOINTMENT OF CONSERVATOR FOR ADULT Page 2 of 8 Primary P hone: Alternate P hone: Email Address: Does Petitioner need an interpreter? No Yes (Language:) 4. Information about the r espondent: Name: A ge: Date of Birth: Street Address: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Does Respondent need an interpreter? No Yes (Language:) If this appointment is made, the R 5. Information about t he r , partner in a civil union, or adult who has resided with the r espondent for more than 6 months in the last year : Name: Relationship to Respondent: Street Address: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary phone: Alternate phone: Email Address: Does this person need an interpreter? No Yes (Language:) 6. Venue for this proceeding is proper in this county because the r espondent resides in this county. does not reside in this state but has property in this county. 7. A Power of Attorney exists for financial or medical matters. ( Attach a copy to the p etition. ) T he agent s name and mailing address are : 8. A valid d esignated b eneficiary agreement exists. ( Attach a copy of the agreement to the p etition. ) The name and mailing address are : 9. A c onservator is required because the r espondent is unable to manage property and business affairs because he or she is unable to effectively receive and evaluate information or both or to make or American LegalNet, Inc. www.FormsWorkFlow.com JDF 8 76 SC R 6 /1 9 PETITION FOR APPOINTMENT OF CONSERVATOR FOR ADULT Page 3 of 8 communicate decisions, even with the use of appropriate and reasonably available technological assistance due to the following disabilities or impairments : l etter attached. In addition: the r espondent has property which will be wasted or dissipated unless proper management is provided . and/ or the r espondent, or persons entitled to the r education , health, and welfare, and protection is necessary or desirable to obtain or provide money. 10. A c onservator i s required because t he r espondent is missing, detained, or unable to return to the United States . The nature of the r r espondent are as follows: 11. The p etitioner requests the s pecial c powers and duties be unlimited/unrestricted or limited/with restrictions . The property to be placed under the s pecial c requested limitations/restrictions on the s pecial c 12. The p etitioner requests the c powers and duties be unlimited/unrestricted or limited/with restrictions . T he property to be placed under the c the requested limitations/restrictions on the c , if any, are as follows: American LegalNet, Inc. www.FormsWorkFlow.com JDF 8 76 SC R 6 /1 9 PETITION FOR APPOINTMENT OF CONSERVATOR FOR ADULT Page 4 of 8 13. Petitioner is , 21 years of age or older , nominates himself or herself and requests to be appointed as c onservator or s pecial c onservator. or Petitioner nominates the following person , who is 21 years of age or older, to be appointed as c onservator or s pecial c onservator. Name: List all names used (also known as, formerly known as, etc.): Relationship to Respondent: Street Address: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary phone: Alternate phone: Email Address: Does this person need an interpreter? No Yes (Language:) 14. The nominated c onservator has priority for appointment because he or she is : ( 247 15 - 14 - 413, C.R.S. ) a c onservator, g uardian , or other fiduciary appointed or recognized by a court in another jurisdiction where the protected person resides. nominated in writing by r espondent , including nomination in a durable power of attorney or designated beneficiary agreement. an agent appointed by the r espondent to manage the r a ttorney. the s pouse or partner in a civil union of the r espondent . an adult child of the r espondent . a p arent of the r espondent . a n a dult with whom r espondent has resided for more than 6 months immediately before the filing of this p etitio n. 15. The r espondent nominated the following person as c onservato r , but the p etitioner does not seek that Name: List all names used (also known as, formerly known as, etc.): Relationship to Respondent : Street Address: City: State: Zip Code: American LegalNet, Inc. www.FormsWorkFlow.com JDF 8 76 SC R 6 /1 9 PETITION FOR APPOINTMENT OF CONSERVATOR FOR ADULT Page 5 of 8 Mailing Address, if different: City: State: Zip Code: Primary phone: Alternate phone: Email Address: 16. The c onservator may receive compensation. The hourly rates to be charged, any amounts to be charged pursuant to a published fee schedule, including the rates and basis for charging fees for any extraordinary services, and any other bases upon which a fee charged to the estate will be calculated , are as stated below or in an attachment to this p etition . * The basis of compensation has not yet been determined. * There is a continuing obligation to disclose any material changes to the basis for charging fees. (247 15 - 10 - 602 C.R.S.) 17. The c onservator may compensate his, her, or its counsel. The hourly rates to be charged, any amounts to be charged pursuant to a published fee schedule, including the rates and basis for charging fees for any extraordinary services, and any other bases upon which a fee char ged to the estate will be calculated , are as stated below or in an attachment to this p etition . * The basis of compensation has not yet been determined. * There is a continuing obligation to disclose any material changes to the basis for charging fees. (247 15 - 10 - 602 C.R.S.) 18. Sections a and b below identify assets and the source and amount of anticipated income or receipts (public benefits, income, real property, proceeds from insurance policy, proceeds from pension, etc.) , together with an estimate of the value . a. The r espondent assets are: Description of Assets ( e.g. b ank a ccounts, insurance, pensions, p roperty ) None . Estimated Value $ Total $ American LegalNet, Inc. www.FormsWorkFlow.com JDF 8 76 SC R 6 /1 9 PETITION FOR APPOINTMENT OF CONSERVATOR FOR ADULT Page 6 of 8 b. T he r espondent is : Description of Income ( e.g. s ocial s ecurity, pension and insurance ) None . Estimated Amount of Income $ Total $ 19. T he following person is currently acting as a g uardian and/ or c onservator in Colorado or elsewhere : Name: Relationship to Respondent: Street Address