State of Minnesota County of ____________________ District Court Probate Division Judicial District: __________________ Court File No. _____________________ Case Type: 14, Conservatorship In Re: Conservatorship of ______________________________, Protected Person Annual Notice of Right to Petition for Termination or Modification of Conservatorship and Other Relief Minn. Stat. § 524.5-409, subd. 1(e) To: _____________________________________ Protected Person You have a right to ask the Court to end or modify the conservatorship, or for any order that is in your best interests or for other appropriate relief, by filing a petition with the Court explaining why you believe the conservatorship should end, be modified, or why other relief is needed. If you wish to have a different conservator then you must file a petition for removal of the conservator, explaining why you believe the present conservator should be removed. To petition the court you may call the Probate Court Monday through Friday between 8:00 a.m. and 4:30 p.m. and ask that a form be sent to you, pick up the proper form at the Court, or access forms from the court's public website at www.mncourts.gov/forms. The phone number and address of the Court is: After a petition is filed the Court will schedule a hearing. You have the right to be present at that hearing and to have a lawyer represent you. If you cannot afford a lawyer, the Court will appoint one for you. You may call the Court to request a Court appointed attorney. THIS NOTICE MUST BE SERVED ANNUALLY ON THE PROTECTED PERSON AND INTERESTED PERSONS OF RECORD WITH THE COURT WITHIN THIRTY DAYS AFTER THE ANNIVERSARY OF THE APPOINTMENT OF THE CONSERVATOR. AN INTERESTED PERSON MAY NOTIFY THE COURT IN WRITING THAT THE INTERESTED PERSON DOES NOT WISH TO RECEIVE COPIES OF ANNUAL REPORTS AS REQUIRED BY LAW. Dated: Signature of Conservator GAC 10-C State ENG Rev 8/16 www.mncourts.gov/forms Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT OF SERVICE State of Minnesota County of ) ) SS ) ______________________________________, states that a copy of the Notice of Rights to Petition for Termination or Modification of Conservatorship and Other Relief has been given to the Protected Person and to interested persons of record with the court. The Protected Person was served to Petition on of the Protected Person is by mail or personally with the Annual Notice of Rights (date). The present address and telephone number The following interested persons of record with the court were served at the location listed with a copy of the Annual Notice of Rights to Petition: (attach additional sheets if necessary) Name: Address Served by mail or personally on (date) Name: Address Served Name: Address Served Name: Address Served by mail or personally on (date) by mail or personally on (date) by mail or personally on (date) I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated Signature of Conservator Name: Address: City/State/Zip: ________________________ Telephone: ( ) E-mail address: FILE THE ORIGINAL AFFIDAVIT OF SERVICE WITH THE COURT GAC 10-C State ENG Rev 8/16 www.mncourts.gov/forms Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com