Nebraska State Court Form REQUIRED ACCEPTANCE OF APPOINTMENT OF GUARDIAN AND CONSERVATOR IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF Ward/Incapacitated Person/Protected Person Case ACCEPTANCE OF APPOINTMENT OF GUARDIAN AND CONSERVATOR I, accept appointment as guardian and conservator of the assets name of guardian and conservator of , and swear that I will perform, according to law, all duties ward/incapacitated person/protected person as guardian and conservator. I acknowledge my responsibilities as guardian and conservator by initialing all of the following: Acknowledgments before Letters are issued to establish my authority to serve as guardian and conservator:CC 16:2.2.5 Revised American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 Acceptance of Appointment of Guardian and Conservator CC 16:2.2.5 Rev person/protected person has accounts. I shall also file with the court a (confidential) 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. Within 90 days of my appointment, I shall complete a guardianship/conservatorship training class and file proof of completion with the court. I shall file my etters of Guardianship and Conservatorship with the Register of Deeds in any county where the ward/incapacitated person/protected person has real property or an interest in real property. One year after my appointment and every year thereafter, I shall file with the court: 1.Annual Report of Guardian on Condition of Ward form (CC 16:2.14).2.Updated Inventory form (CC 16:2.45).3.Annual Accounting form (CC 16:2.44).4.Certificate of Proof of Possession form (CC 16:2.13). If any funds are restricted, the bank ordepository must indicate a restriction to the account on the certificate: 223No withdrawals without courtorder.224 5. Copies of all bank statements and/or brokerage statements for the dates covered by the accounting.If full account numbers, social security numbers, dates of birth or other personal information appearon the bank statements and/or brokerage statements, I shall black out all but the last four digitsbefore sending them to the interested . 6.Personal and Financial Information for Guardianships and Conservatorships form (CC 16:2.23)showing complete account numbers of accounts, etc. listed on Inventory and Certificate of Proof ofPossession. The form contains confidential information and is not shared with the parties except bycourt order. I acknowledge all of the documents, except the Personal and Financial Information for Guardianships and Conservatorships form, shall be sent to all interested along with Notice of Right to Object form (CC 16:2.16). I acknowledge that I shall file with the court a Certificate of Mailing (CC 16:2.24) showing I mailed all of the documents to all interested by first class mail, postage pre-paid. I shall notify the court of the change of address of the ward/incapacitated person/protected person within three days of the change. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 Acceptance of Appointment of Guardian and Conservator CC 16:2.2.5 Rev I shall not move the ward/incapacitated person/protected person to a location outside of the State of Nebraska without court permission. I shall notify the court of the ward222s/incapacitated person222s/protected person222s death within three days. I shall file with the court a Notice of Newly Discovered Assets form (CC 16:2.18) within 30 days after I become aware of any additional assets, gifts, awards, settlements or inheritances over $500.00 not disclosed in the most current inventory. I shall not make any ATM withdrawals and/or get cash back from a debit transaction without a court order. I have reviewed these requirements with my attorney (if I have one) and have received all forms necessary to comply with my duties. I have no further questions of my attorney at this time (If you do not have an attorney, please indicate 223not applicable224 and go to next acknowledgment). I have received the forms needed to comply with the above requirements (If you do not have an attorney, you may get the forms on the Nebraska Supreme Court website, ). Signature(s) of Guardian(s) and Conservator(s) Date Print or Type Name of Guardian(s) and Conservator(s) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box of Guardian(s) and Conservator(s) City/State/ZIP Code of Guardian(s) and Conservator(s) Phone(s) E-mail Address(es) American LegalNet, Inc. www.FormsWorkFlow.com