Nebraska State Court Form ORDER APPOINTING GUARDIAN AND CONSERVATOR Page 1 IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF Ward/Incapacitated Person/Protected Person Case ORDER APPOINTING GUARDIAN AND CONSERVATOR The Petition for Appointment of Guardian and Conservator having come before the court, the coan incapacitated person, pursuant to lawful proceedings of record in this court, oran incapacitated person, pursuant to the provisions of the Last Will and Testament of , parent or spouse of said incapacitated person, which Will was admitted to probate in this court5.Upon clear and convincing evidence presented to the court, there is a sufficient basis for theappointment of the conservator for and there are no lessrestrictive alternatives than the appointment of a conservator for the above-named protected6.Appointment of a guardian and conservator is necessary because American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 5 The court finds clear and convincing evidence that a full guardianship is necessary and is theleast restrictive alternative. The guardian is granted all powers conferred upon guardiansby law which are listed below:i.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 services appropriate for theward;vi.Applying for private or governmental benefits to which the ward may be entitled;vii.Instituting proceedings to compel any person under a duty to support the ward or topay sums for the welfare of the ward to perform such duty, if no conservator has beenappointed;viii.Entering into contractual arrangements on behalf of the ward, if no conservator hasbeen appointed; andix.Receiving money and tangible property deliverable to the ward and applying suchmoney and property to the ward's expenses for room and board, medical care,personal effects, training, education, and habilitating services, if no conservator hasbeen appointed, or requesting the conservator to expend the ward's estate bypayment to third persons to meet such expenses. This is a limited guardianship. You, as guardian, shall have the following authorities andresponsibilities (acting together with the ward or singly):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 of the ward;Arranging for training, education, or other habilitating services appropriate for theward;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 topay sums for the welfare of the ward to perform such duty, if no conservator has been American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 5 appointed; Entering into contractual arrangements on behalf of the ward, if no conservator hasbeen appointed; andReceiving money and tangible property deliverable to the ward and applying suchmoney and property to the ward's expenses for room and board, medical care,personal effects, training, education, and habilitating services, if no conservator hasbeen appointed, or requesting the conservator to expend the ward's estate bypayment to third persons to meet such expenses.Other: 7. is entitled to appointment pursuant to Neb. Rev. Stat. 247 30-2639and 247 30-2627 and should be appointed as guardian and conservator. The above named person isauthorized and ordered to obtain an Acknowledgment of Financial Institution completed by eachfinancial institution holding any assets or accounts titled in any manner in the name of the protectedperson along with a printout of all assets and account numbers in each financial institution, whichshall be filed in these proceedings. 8.If any funds are ordered restricted, the above named person is further authorized and orderedto open an account at a financial institution with the restriction that no withdrawals can bemade without a court order. To show the court that the guardian/conservator has compliedwith this restriction, the guardian/conservator shall file with the court a Proof of RestrictedAccount form within 10 days of this order.9.Bond:Is required and set in the sum of $;Is not required because the assets of the ward/protected person are less than $10,000 invalue; Is not required because the court finds good cause: ( all that apply) All assets are ordered into restricted accounts.Other: American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 5 10.Training:The guardian/conservator shall complete training within 90 days;For good cause shown training is waived;IT IS THEREFORE ORDERED that is appointed guardian and conservator of the estate of and Letters of Guardianship and Conservatorship shall be issued to the guardian/conservator upon the filing of the following documents: 1.Acceptance of Appointment;2.General Information Form;3.Address Information Form; 4. Acknowledgment of Financial Institution with a printout of all assets in each financial institution; 5.Proof of restricted funds form for any assets the court has ordered to be held in a restrictedaccount;6.Inventory and Affidavit of Due Diligence;7.Personal and Financial Information for Guardianships and Conservatorships form;8.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 and conservator. The guardian/conservator shall deliver to each financial institution where the incapacitated person/protected person has accounts/assets a copy of the Letters of Guardianship and Conservatorship 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 and conservator shall thereafter be entitled to deal with such assets. This form shall be filed within 10 days. Failure to file this form will result in a suspension of your authority. As a Guardian and Conservator you are ordered to comply with the following restrictions: 1. The guardian(s)/conservator(s) shall not pay himself/herself/themselves or his/her/their attorneycompensation from the assets or income of the protected person nor sell real property of theestate without first obtaining an Order from the court. To obtain an Order, you must first file anapplication, give notice to interested persons, then have a hearing date scheduled. The Ordermay be entered without a hearing if all interested have waived notice of hearing or have American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 5 executed their consent to such compensation or sale or any other restrictions as determined to be appropriate by the court. 2.The guardian/conservator shall not make any ATM withdrawals or receive cash back on debittransactions without a court order.3.If any funds have been restricted by the court, the guardian/conservator shall not make anywithdrawals from the restricted account without a court order. 4.Other: DATED BY THE COURT: County Judge PREPARED AND SUBMITTED BY: American LegalNet, Inc. www.FormsWorkFlow.com