Page 1 of 3 Acceptance of Appointment of Conservator By the Public Guardian CC 16:2.214 Nebraska State Court Form REQUIRED ACCEPTANCE OF APPOINTMENT OF CONSERVATOR BY THE PUBLIC GUARDIAN CC 16:2.214 IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF Protected Person Case ACCEPTANCE OF APPOINTMENT OF CONSERVATOR BY THE PUBLIC GUARDIAN The Public Guardian accepts appointment as conservator of the assets of Name of protected person , a protected person, and swears they will perform, according to law, all duties as conservator. The Public Guardian acknowledges the responsibilities as conservator by initialing all of the following: Acknowledgements before The Public Guardian shall file with the court an Address Information for Guardianships Conservatorships form (CC 16:2.5). The General Information Form, unless waived by the court for good cause shown. The Public Guardian shall file with the court the Public Guardian Notice of Designation of Deputy Public Guardian and Associate Public Guardians form (CC 16:2.96). The Public Guardian shall file with the court an updated Public Guardian Notice of Designation of Deputy Public Guardian and Associate Public Guardians form (CC 16:2.96) if the designation changes after the initial filing. If funds are restricted by court order, within ten days of appointment he Public Guardian shall file Within 30 days of appointment he Public Guardian shall file with the court an Ac American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 Acceptance of Appointment of Conservator By the Public Guardian CC 16:2.214 Within 30 days of appointment, he Public Guardian shall file with the court a Budget that pursuant to Neb. Ct. R 247 6-1433.02(D) is for informational purposes only, and the Inventory, Affidavit of Due Diligence, and Certificate of Mailing form (CC 16:2.9) of the protected person222s assets. Acknowledgements after Letters are issued: The Public Guardian shall file with the court an Acknowledgement of Financial Institution form (CC 16:2.6) showing a copy of the Letters Appointing the Public Guardian as Conservator were given to all financial institutions where the protected person has accounts. The Public Guardian shall also file with the court an updated Personal and Financial Information for Guardianships and Conservatorships form (CC 16:2.23) with full account numbers and printouts of all assets and account numbers. The Public Guardian shall file the Letters Appointing the Public Guardian as Conservator with the Register of Deeds in any county where the protected person has real property or an interest in real property. One year after appointment and every year thereafter, he Public Guardian shall file with the court: 1.Updated Inventory (CC 16:2.45).2.Annual Accounting3.Certificate of Proof of Possession (CC 16:2.13). If any funds are restricted, the bank ordepository must indicate a restriction to the account on the certificate: 223No withdrawals withoutcourt order.224 4. Copies of all statements and/or brokerage statements for the dates coveredbythe accounting. If full account numbers, social security numbers, dates of birth or otherpersonal information appear on the accounting statements and/or brokerage statements, allbut the last four digits shall be blacked out before sending them to the interested persons. 5.Personal and Financial Information for Guardianships and Conservatorships form (CC16:2.23) showing complete account numbers of accounts, etc. listed on inventory andcertificate of proof of possession. This form contains confidential information and is notshared with the parties except by court order. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 The Public Guardian shall notify the court of the change of address of the protected person within three days of the change. The Public Guardian shall not move the protected person to a location outside of the State of Nebraska without court permission. The Public Guardian shall notify the court of the protected person222s death within three days. The Public Guardian shall file with the court a Notice of Newly Discovered Assets form (CC 16:2.18) within 30 days after becoming aware of any additional assets, gifts, awards, settlements or inheritances over $500.00 not disclosed in the most current inventory. The Office of Public Guardian is prohibited from making ATM withdrawals or receiving cash back on debit transactions. Date Signature(s) Print or Type Name Bar Number and Firm Name (attorneys only) Street Address/P.O. Box City/State/ZIP Code Phone e-mail Address Acceptance of Appointment of Conservator By the Public Guardian CC 16:2.214 American LegalNet, Inc. www.FormsWorkFlow.com