GN-3370, 05/18 Consent to Serve as Conservator 247247223.105(2) and 54.76, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Name Date of Birth Amended Consent to Serve as Conservator Case No. I STATE THAT: 1. I am nominated to serve as permanent standby successor conservator of the above-named individual and consent to serve as conservator and will act in the best interest of this individual. 2. If appointed as conservator, I will file an inventory within 60 days of appointment, and accountings annually or as otherwise required by the court. 3. I will exercise all powers and perform all duties as conservator as required by law. Signature Name Printed or Typed Street Address City, State, Zip Date Telephone Number American LegalNet, Inc. www.FormsWorkFlow.com