Page 1 of 3 Nebraska State Court Form REQUIRED IN THE COUNTY COURT OF COUNTY, NEBRASKA Case IN THE MATTER OF Protected Person ORDER APPOINTING The Petition for Appointment of Conservator having come before the court, the court finds as follows: 1.Petitioner(s) is/are entitled to file the Petition 4.Upon clear and convincing evidence presentedless restrictive alternatives than the appointment of a conservator for the5.Appointment of a conservator is necessary because 6.Proper notice has been given to the Office of Public Guardian.7.The petitioner has acted in good faith and due diligence to identify a conservator who wouldserve in the best interest of the protected person.8.The appointment of the Office of Public Guardian is necessary and does not exceed thecaseload limitations as set forth by statute.CC 16:2.119 New 10/15 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 11. The Public Guardian is entitled to appointment pursuant to Neb. Rev. Stat. 247 30-2639 and30-4112 and should be appointed conservator. The Public Guardian is authorized andorderedtoobtain an Acknowledgment of Financial Institution completed by each financialinstitutionholdingany assets or accounts titled in any manner in the name of the protectedpersonalong with aprintout of all assets and account numbers in each financial institution, whichshallbe filed in theseproceedings. 12.If any funds are ordered restricted, the Public Guardian is further authorized and ordered to openan account at a financial institution with the restriction that no withdrawals can be made withouta court order. To show the court that they complied with this restriction, the Public Guardian shallfile with the court a Proof of Restricted Account form within 10 days of this order. 13. Bond is not required per Neb. Rev. Stat. 24730-2627(e). 14.Training: For good cause shown training is waived. The Public Guardian and the AssociatePublic Guardians have already taken the training. 15.The Public Guardian shall file the Notice of Designation of Deputy Public Guardian and Associate Public Guardians form (CC 16:2.96) with the court indicating who the designatedAssociate Public Guardian is for this case. If the Associate Public Guardian changes, thePublic Guardian shall file an updated Notice of Designation of Deputy Public Guardian andAssociate Public Guardians form (CC 16:2.96) with the court indicating who the newdesignated Associate Public Guardian is for this case. IT IS THEREFORE ORDERED that the Public Guardian is appointed conservator of the estate of and Letters Appointing the Public Guardian as Conservator shall be issued to the Public Guardian upon the filing of the following documents: 1.Acceptance of Appointment;2.Address Information Form; 3. General 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 restricted;6.Inventory, Affidavit of Due Diligence, and Certificate of Mailing form;7.Budget that pursuant to Neb. Ct. Rule 247 6-1433.02(D) is for informational purposes only;8.Personal and Financial Information for Guardianships and Conservatorships form. American LegalNet, Inc. www.FormsWorkFlow.com PREPARED AND SUBMITTED BY: Page 3 of 3 Upon completion of the filing requirements above and sending the appropriate forms to all interested persons, letters will be issued which will appoint the Public Guardian as conservator. The Public Guardian shall deliver to each financial institution where the protected person has accounts/assets a copy of the Letters Appointing the Public Guardian as Conservator 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 Public Guardian 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 conservator the Public Guardian is ordered to comply with the following restrictions: 1.The Public Guardian shall not pay compensation to themselves from assets or income of the protected person, nor sell real property of the estate without first giving notice tointerested persons and obtaining an order of the court. To obtain an Order, the PublicGuardian must first file an application, give notice to interested persons, then have ahearing date scheduled. The order may be entered without a hearing if all interestedpersons have waived notice of hearing or have executed their written consent to suchcompensation or sale or any other restrictions as determined to be appropriate by thecourt. 2.The Office of Public Guardian is prohibited from making ATM withdrawals or receivingcash back on debit transactions.3.If any funds have been restricted by the court, the Public Guardian shall not make anywithdrawals from the restricted account without a court order.4.Other: DATED . BY THE COURT: County Judge American LegalNet, Inc. www.FormsWorkFlow.com