ORDER APPOINTING GUARDIAN Page 1 of 4 Order Appointing Guardian CC 16:2.1.1 Rev IN THE COUNTY COURT OF COUNTY, NEBRASKAIN THE MATTER OF Case ORDER APPOINTING GUARDIAN Ward/Incapacitated Person The Petition for Appointment of Guardian having come before the court, the court finds as follows:4.Upon clear and convincing evidence presented to the court, there is a sufficient basis for theappointment of the guardian for, an incapacitated person, pursuant to lawful proceedings of record in this court, oran incapacitated pers, parent or spouse of said incapacitated person, which Will was admitted to probate in this court. There are no less restrictive alternatives than the appointment of a guardian for the above-named incapacitated person.Appointment of a guardian is necessary because The coui. Selecting the ward's place of abode within or without this state; ii. Arranging for medical care for the ward; iii. Protecting the personal effects of the ward; iv. Giving necessary consent, approval, or releases on behalf of the ward; v. Arranging for training, education, or other habilitating servicesvi. Applying for private or governmental benefits to which the ward may be entitled; Nebraska State Court Form REQUIRED American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 4 Order Appointing Guardian CC 16:2.1.1 Rev vii.Instituting proceedings to compel any person under a duty to support the ward or to pay sumsfor the welfare of the ward to perform such duty, if no conservator has been appointed;viii.Entering into contractual arrangements on behalf of the ward, if no conservator has beenappointed; andix.Receiving money and tangible property deliverable to the ward and applying such money andproperty to the ward's expenses for room and board, medical care, personal effects, training,education, and habilitating services, if no conservator has been appointed, or requesting theconservator to expend the ward's estate by payment to third persons to meet such expenses.This is a limited guardianship. You, as guardian, shall have only the following authorities andresponsibilities (acting together with the ward or individually):Selecting the ward's place of abode within or without this state;Arranging for medical care for the ward;Protecting the personal effects of the ward;Giving necessary consent, approval, or releases on behalf ofthe ward;Arranging for training, education, or other habilitating services appropriate for the ward;Applying for private or governmental benefits to which the ward may be entitled;Instituting proceedings to compel any person under a duty to support the ward or to pay sums forthe welfare of the ward to perform such duty, if no conservator has been appointed;Entering into contractual arrangements on behalf of the ward, if no conservator has beenappointed; andReceiving money and tangible property deliverable to the ward and applying such money andproperty to the ward's expenses for room and board, medical care, personal effects, training,education, and habilitating services, if no conservator has been appointed, or requesting theconservator to expend the ward's estate by payment to third persons to meet such expenses.Other: 7.is entitled to appointment pursuant to Neb. Rev. Stat. 247 30-2627 and should be appointed as guardian. The above named person is authorized and ordered to obtain an Acknowledgment of Financial Institution form completed by each American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 4 Order Appointing Guardian CC 16:2.1.1 Rev financial institution holding any assets or accounts titled in any manner in the name of the ward/protected person along with a printout of all assets and account numbers in each financial institution, which shall be filed in these proceedings. 8.If any funds are ordered restricted, the above named person is further authorized and ordered toopen an account at a financial institution with the restriction that no withdrawals can be madewithout a court order. To show the court that the guardian has complied with this restriction,the guardian shall file with the court a Proof of Restricted account form within ten days of thisorder.9.Bond: Is required and set in the sum of $; Is not required because the assets of the ward/incapacitated person are less than $10,000 invalue;Is not required because the court finds good cause: ( all that apply)a.All assets are ordered into restricted accounts.b.Guardian has no authority over assets of the estate. c. 10.Training:The guardian shall complete training within 90 days;For good cause shown training is waived; IT IS THEREFORE ORDERED that shall be appointed guardian(s) of upon Letters of Guardianship being issued to the guardian(s) and upon the guardian(s) filing the following documents with the court: 1.Acceptance of Appointment;2.General Information form;3.Address Information Sheet; 4. Acknowledgment of Financial Institution with a printout of all assets in each financial institution; 5.Inventory and Affidavit of Due Diligence;6.Personal and Financial Information for Guardianships and Conservatorships form; American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 4 Order Appointing Guardian CC 16:2.1.1 Rev 7.Approved bond, if required. Upon completion of the filing requirements above and sending the appropriate forms to all interested , Letters will be issued which will appoint you as guardian. The guardian shall deliver to each financial institution where the protected person has any accounts/assets a copy of the Letters of Guardianship and file with the court an Acknowledgment from the Financial Institution that they received the Letters, along with a printout of all assets and account numbers in each financial institution. The guardian shall thereafter be entitled to deal with such assets. This form shall be filed within ten days. Failure to file this form will result in a suspension of your authority. As a guardian you are ordered to comply with the following restrictions: 1. The guardian(s) shall not pay himself/herself/themselves or his/her/their attorney compensationfrom the assets or income of the protected person nor sell real property of the estate without firstobtaining an Order from the court. To obtain an order, you must first file an application, givenotice to interested persons, then have a hearing date scheduled. This Order may be enteredwithout a hearing if all interested have waived notice of hearing or have executed theirconsent to such compensation or sale or any other restrictions as determined to be appropriateby the court. 2. The guardian shall not make any ATM withdrawals or receive cash back on debit transactionswithout a court order. 3.Other: DATED BY THE COURT: County Judge PREPARED AND SUBMITTED BY: American LegalNet, Inc. www.FormsWorkFlow.com