JDF 783 SC R 6 /1 9 PETITION REQUESTING COL O RADO TO ACCEPT GUARDIANSHIP/CONSERVATORSHIP Page 1 of 2 District Court Denver Probate Court County, Colorado Court Address: In the Interest of: Ward/ Protected Person COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION REQUESTING COLORADO TO ACCEPT GUARDIANSHIP CONSERVATORSHIP FROM SENDING STATE This p etition is submitted pursuant to 247 15 - 14.5 - 302, C.R.S. of the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act. The g uardian and/or c onservator p etitioner , hereby submit s certified c op ies of any documents evidencing authority to act ( Order of Appointment , Letters) and the Provisional Order of Transfer from the sending state relating to a Guardianship Conservatorship , as identified below: Sending State: Sending Court: Sending Court Case #: 1. Information about the g uardian and/or c onservator : Name: Street Address: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary Phone: Alternate P hone: Email Address: 2. Information about the w ard/ p rotected p erson: Name: Street Address: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary Phone: Alternate Phone: Email Address: Type of Residence: Private Nursing Home Assisted Living Home Other: 3. The p etitioner requests that Colorado accept this g uardianship/ c onservatorship for the following reasons: American LegalNet, Inc. www.FormsWorkFlow.com JDF 783 SC R 6 /1 9 PETITION REQUESTING COL O RADO TO ACCEPT GUARDIANSHIP/CONSERVATORSHIP Page 2 of 2 4. The p etitioner must provide this p etition and a Notice of H earing Without Appearance (JDF 712) to persons entitled to notice. (247 1 5 - 14.5 - 302(2), C.R.S.) 5. The interested persons given notice are as follows: Name of Interested Person Requiring Notice in Sending State Relationship to Ward/ Protected Person Name of Interested Person Requiring Notice in Colorado , not listed above Relationship to Ward/ Protected Person By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the day of Executed on the day of (date) (date) , , , , (month) (year) (month) (year) at at (city or other location, and state OR country) (city or other location, and state OR country) (printed name) (printed name) (Signature of Petitioner) (Signature of Co - Petitioner, if any) Attorney Signature, (if any) Date American LegalNet, Inc. www.FormsWorkFlow.com