State of Minnesota County of ____________________ District Court Probate Division Judicial District: __________________ Court File No. _____________________ Case Type: 14, Conservatorship AFFIDAVIT IN SUPPORT OF PETITION TO SELL REAL PROPERTY In Re: Conservatorship of ____________________________, Protected Person STATE OF MINNESOTA COUNTY OF ) ) SS ) The undersigned, ______________________, hereby states and alleges as follows: 1. That affiant is the duly appointed conservator of the estate of above-referenced protected person, appointed on _______________________. 2. That the conservator has been and will be responsible for the administration of the conservatorship. 3. That during the time the conservator has been involved in the administration of the conservatorship, the conservator has had an opportunity to review the assets and outstanding bills, has visited the protected person, and has secured and protected the house located at __________________________________________________________________________. 4. That the protected person currently resides at ____________________________. 5. That the income of the conservatorship consists of ___________ in the amount of $_______ per month and income from ____________ in the amount of $__________ per month and from __________ in the amount of $________ per month. 6. That the assets of the conservatorship consist of an interest in the _______ County real estate with an assessed market value of $____________, and the personal property as listed in the inventory of the conservator in the amount of $_________________. GAC 21-UA State ENG Rev 7/15 www.mncourts.gov/forms Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 7. That the real estate taxes, utilities, and insurance expenses in connection with the properties are in excess of $___________ per year. 8. That the homestead should be sold for the following reasons: a. b. The property is earning no income; The protected person is not in need of the house for the protected person's residence; The protected person is not able to return to independent living; By selling the property the conservator would increase the income of the conservatorship; The Department of Economic Assistance requires the property to be sold in order for the conservatee to be eligible for Medical Assistance benefits; and It is in the best interest of the protected person. c. d. e. f. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. FURTHER YOUR AFFIANT SAYETH NOT. Dated:________________ __________________________________ Petitioner / Affiant Name of Petitioner's Attorney: Name: License No. Address: City/State/Zip: E-mail address GAC 21-UA State ENG Rev 7/15 www.mncourts.gov/forms Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com