Page 1 of 5 Nebraska State Court Form REQUIRED CC 16:2.117 IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF Case Ward/Incapacitated Person ORDER APPOINTING THE PUBLIC GUARDIAN AS GUARDIAN 4. Upon clear and convincing evidence presented to the court, there is a sufficient basis fortheappointment of the guardian foran 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 , person, which Will was admitted to probate in this court. 5.Appointment of a guardian is necessary because6.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 guardian who would serve inAmerican LegalNet, Inc. www.FormsWorkFlow.com The court finds clear and convincing evidence that a full guardianship is necessary and is theleast restrictive alternative. The Public Guardian is granted all powers conferred uponguardians by 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 by paymentto third persons to meet such expenses. This is a limited guardianship. The Public Guardian, as guardian, shall have the followingauthorities and responsibilities (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; American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 5 Instituting proceedings to compel any person under a duty to support the ward or to paysums for the welfare of the ward to perform such duty, if no conservator has beenappointed;Entering into contractual arrangements on behalf of the ward, if no conservator has beenappointed;Receiving money and tangible property deliverable to the ward and applying such moneyand property to the ward's expenses for room and board, medical care, personal effects,training, education, and habilitating services, if no conservator has been appointed, orrequesting the conservator to expend the ward's estate by payment to third persons tomeet such expenses.Other: 11. The Public Guardian is entitled to appointment pursuant to Neb. Rev. Stat. 247 30-2627 and 30-4112 and should be appointed as guardian. The Public Guardian is authorized and ordered toobtain an Acknowledgment of Financial Institution completed by each financial institution holdingany assets or accounts titled in any manner in the name of the ward/incapacitated person alongwith a printout of all assets and account numbers in each financial institution, which shall be filedin these proceedings. 12. If any funds are ordered restricted, the Public Guardian is further authorized and ordered to open an 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. American LegalNet, Inc. www.FormsWorkFlow.com 15.The Public Guardian shall file the Notice of Designation of Deputy Public Guardian andAssociate 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, the PublicGuardian shall file an updated Notice of Designation of Deputy Public Guardian and AssociatePublic Guardians form (CC 16:2.96) with the court indicating who the new designatedAssociate Public Guardian is for this case. IT IS THEREFORE ORDERED that the Public Guardian is appointed guardian of the estate of and Letters Appointing the Public Guardian as Guardian 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. 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 guardian. The Public Guardian shall deliver to each financial institution where the incapacitated person/protected person has accounts/assets a copy of the Letters Appointing the Public Guardian as Guardian 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 guardian 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 ward/incapacitated person, nor sell real property of the estate without first giving Page 4 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 5 15 notice to interested persons and obtaining an order of the court. To obtain an Order, the Public Guardian must first file an application, give notice to interested persons, then have a hearing date scheduled. The order may be entered without a hearing if all interested persons have waived notice of hearing or have executed their written consent to such compensation or sale or any other restrictions as determined to be appropriate by the court. 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 PREPARED AND SUBMITTED BY: American LegalNet, Inc. www.FormsWorkFlow.com