SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION In re: ________________________________ An Adult ACCEPTANCE, CONSENT, AND NON-RESIDENT POWER OF ATTORNEY [ ] Conservator of property I hereby accept the duties of the office of [ ] conservator of property [ ] conservator of person [ ] Conservator of person _________ CON _________ of __________________________________ (ward) and consent to personal jurisdiction in any action instituted in the District of Columbia by any interested person against me as conservator of the property or conservator of the person arising from the duties of my office and, if I am a non-resident, I do hereby irrevocably appoint the Register of Wills and successors in office as the person upon whom all notice and process issued by a competent court in the District of Columbia may be served with the same effect as personal service in relation to all suits or matters pertaining to the proceeding in which Letters of conservatorship of the property and/or conservatorship of the person shall issue. ___________________________________ Signature ___________________________________ Typed Name ___________________________________ Address (actual address/not Post Office Box) ___________________________________ ___________________________________ ___________________________________ Telephone number ___________________________________ E-mail Address ___________________________________ Bar Number (if filer is an attorney) July 2010 � 1002.10.v1 American LegalNet, Inc. www.FormsWorkFlow.com