State of Minnesota County of Hennepin District Court Probate Division Judicial District: Fourth Court File No. ______________ Case Type: 14, ___________________ In Re: Guardianship Conservatorship of ________________________________ Acceptance of Appointment By: Individual Corporation BY INDIVIDUAL: I, (name), the appointed Guardian, Conservator, of the above named ward or protected person, verify that I have watched the Guardianship/Conservatorship Educational video and understand the duties and responsibilities of the role for which I am being appointed. I hereby accept my appointment and do solemnly swear that I will fully and faithfully perform all the duties of such office according to law and that I submit to the jurisdiction of the Court in any proceeding relating to this ward or protected person that may be instituted by the court or any person interested in the affairs of the ward or protected person. So help me God. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated: , 20___ Signature Name: Address: City/State/Zip: Telephone: E-mail address: Date of Birth mm/dd/yy: __________________________ BY CORPORATION: ("Corporation") is a corporation under the Laws of the State of Minnesota. As a condition to receiving letters as Guardian, Conservator, the Corporation (1) accepts the duties of such office, (2) agrees to be bound by Minnesota law relating to guardians and conservators, (3) submits to the jurisdiction of the Court in any proceeding relating to this ward or protected person that may be instituted by the court or any person interested in the affairs of the ward or protected person, and (4) employees of the corporation directly responsible for carrying out the duties and responsibilities of a guardian and/or conservator have watched the Guardianship/Conservatorship Educational Video and understand the duties and responsibilities of the role of guardian and/or conservator. The Corporation has authorized this acceptance to be signed in the corporate name. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated: , 20___ BY: ITS: Address: City/State/Zip: Telephone: E-mail address: www.mncourts.gov/forms Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com GAC 1-U Hennepin ENG Rev 3/16