CC 16:2.38 Rev. Application for Waiver Nebraska State Court Form REQUIRED APPLICATION FOR WAIVER CC 16:2.38 IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF THE GUARDIANSHIP/CONSERVATORHIP OF Ward/Incapacitated Person/Protected Person Case APPLICATION FOR WAIVER, NOTICE COMES NOW, , applicant, and moves the court for an order waiving: Address Information Sheet My reason(s) for requesting said waiver(s) are: Applicant requests that the courtPage 1 American LegalNet, Inc. www.FormsWorkFlow.com CC 16:2.38 Rev. Application for Waiver I acknowledge that I will receive a Notice of Hearing from the court when I file my Application for Waiver. After I receive the Notice of Hearing from the ounty ourt, it is my responsibility to send a copy of: 1.This Application for Waiver; 2. ; and 3. to all interested persons no less than 14 days prior to the hearing date. I must then file with the court a Certificate of Mailing showing I sent this Application for Waiver, Notice of and the Notice of to all interested persons. I swear or affirm, under the penalties of perjury, that I have examined the above documents, and to the best of my knowledge and belief, they are true, correct and complete. Signature(s) of Guardian(s) and/or Conservator(s) Date Print or Type Name of Guardian(s) and/or Conservator(s) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box of Guardian(s) and/or Conservator(s) City/State/ZIP Code of Guardian(s) and/or Conservator(s) Phone(s) E-mail Address(es) Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com CC 16:2.38 Rev. Application for Waiver NOTICE OF RIGHT TO OBJECT TO THE GUARDIAN AND/OR CONSERVATOR: As uardian and/or onservator, you must complete and mail this form to all interested parties and file it with the court. , guardian, has filed the following in the You are notified that above referenced case on Date document(s) filed Application for Waiver Other: If you object to the contents or accuracy of these filings, you may file an objection before the date of the scheduled hearing. The Objection form can be obtained on the Nebraska Supreme Court website, Signature(s) of Guardian(s) and/or Conservator(s) Date Print or Type Name of Guardian(s) and/or Conservator(s) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box of Guardian(s) and/or Conservator(s) City/State/ZIP Code of Guardian(s) and/or Conservator(s) Phone(s) E-mail Address(es) Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com CC 16:2.38 Rev. Application for Waiver CERTIFICATE OF MAILING TO THE GUARDIAN AND/OR CONSERVATOR: You need to complete and file this form with the court showing that you mailed the required documents marked below to all the interested parties you list below. I, , swear or affirm, under the penalties of perjury, that on , I mailed copies of the forms marked below to all interested persons* and bonding company, if any, at the addresses set forth below: Application for Waiver; ; and NAME ADDRESS See attached (more names and addresses than above) Page 4 of 5 Ward/Incapacitated Person/Protected Person Case Date Signature(s) of Guardian(s) and/or Conservator(s) Print or Type Name of Guardian(s) and/or Conservator(s) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box of Guardian(s) and/or Conservator(s)City/State/ZIP Code of Guardian(s) and/or Conservator(s) Phone E-mail Address American LegalNet, Inc. www.FormsWorkFlow.com CC 16:2.38 Rev. Application for Waiver *Interested persons are defined as:children and spouses;future heirs if the ward/incapacitated person/protected person would die without leaving a validwill (brothers and sisters who are adults, grandparents, etc.);a trustee of any trust executed by the ward/incapacitated person/protected person;if there are no individuals defined as 223interested persons224 above, include any person ororganization named as a 223devisee224 in the ward222s/incapacitated person222s/protected person222smost recent will;after death of the ward/incapacitated person/protected person, interested person also includesthe personal representative of a deceased ward222s/incapacitated person222s/protected person222sestate, the deceased ward222s/incapacitated person222s/protected person222s heirs in an intestateestate, and the deceased ward222s/incapacitated person222s/protected person222s devisees in atestate estate; any governmental agency paying benefits on behalf of the ward/incapacitated person/protectedperson; andany person designated by order of the court to be an interested person. If there are no interested persons identified for a ward/incapacitated person/protected person, the court shall appoint a guardian ad litem (Nebraska Supreme Court Rule 247 6-1449(B)). The cost of the guardian ad litem may be taken from the assets of the ward/incapacitated person/protected person. Page 5 of 5 American LegalNet, Inc. www.FormsWorkFlow.com