Nebraska State Court Form CC 16:2.220 New 11/15 REQUIRED ACCEPTANCE OF APPOINTMENT OF TEMPORARY CONSERVATOR FOR A MINOR Neb. Rev. Stat. §§ 30-2630.01(a) and 30-2630(1) and Neb. Ct. R. § 6-1443(A) IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF Case # Protected Person ACCEPTANCE OF APPOINTMENT OF TEMPORARY CONSERVATOR FOR A MINOR I, ( Name of conservator(s)) , accept appointment as temporary conservator of the assets of , a minor, and swear that I will perform, according to law, (Name of protected person) all duties for the protected person as temporary conservator. Date Signature(s) of Conservator(s) Print or Type Name of Conservator(s) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box of Conservator(s) City/State/ZIP Code of Conservator(s) Phone of Conservator(s) E-mail Address of Conservator(s) Page 1 of 1 Acceptance of Appointment of Temporary Conservator for a Minor CC 16:2.220 New 11/15 American LegalNet, Inc. www.FormsWorkFlow.com