Nebraska State Court Form REQUIRED CERTIFICATE OF MAILING ANNUAL REPORTING FORM(S) Page 1 of 2 Certificate of Mailing Annual Report and Accounting CC 16:2.24 Rev TO THE GUARDIAN AND/OR CONSERVATOR: This form can be used whenfiling supplemental reporting forms. Complete the certificate and mark the forms you are mailing. IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF Ward/Incapacitated Person/Protected Person Case CERTIFICATE OF MAILING ANNUAL REPORTING FORM(S) I, , swear or affirm, under the penalties of perjury, that I have filed the required forms marked below with the court and that on mailed copies of the forms marked below to all interested persons* and bonding company, if any, at the Annual Report of Guardian on Condition of Ward (CC 16:2.14)Updated Inventory (CC 16:2.45)Annual Accounting (CC 16:2.44)Certificate of Proof of Possession (CC 16:2.13) (with proof of restricted account if any fundsare restricted) Bank tatements Notice of Right to Object (CC 16:2.16)Certificate of Mailing NAME(S) OF INTERESTED PERSON(S) ADDRESS(ES) See attached (more names and addresses than above)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 Page 2 of 2 Certificate of Mailing Annual Report and Accounting CC 16:2.24 Rev *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 nmost recent will;after death of the ward/incapacitated person/protected person, interested person also includes heirs in an intestate 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. American LegalNet, Inc. www.FormsWorkFlow.com