Guardian Conservator General Information {CC-16-2-4}

Nebraska State Court Form GUARDIAN/CONSERVATOR GENERAL INFORMATION Page 1 of 2 Guardian/Conservator General Information CC 16:2.4 ReIN THE COUNTY COURT OF COUNTY, NEBRASKAIN THE MATTER OF Ward/Incapacitated Person/Protected Person Case CONFIDENTIAL GUARDIAN/CONSERVATOR GENERAL INFORMATION Guardianship: Your relationship to the ward/incapacitated person/protected person: Your Full Name: (Last) (First) (Middle) (Maiden) Home Address: (Street) (City) (Z Code) Business Address: (Street) (City) (State) (Z Code) Telephone No.: Home Work Cell Employer: Occupation: Date of Birth: Social Security No.: -State: # Spouse Full Name: (Last) (First) (Middle) (Maiden) Business Address: (City) (Z Code) Work Cell (Street) Telephone No.: Home Email address: Employer: Occupation: REQUIRED CC 16:2.4 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Guardian/Conservator General Information CC 16:2.4 Rev 01/15 RELATIVES WHO WILL ALWAYS KNOW HOW TO CONTACT YOU: Name: Phone: Email address: Address: (Street) (City) (State) (Z Code) Name: Phone: Email address: Address: (Street) (City) (State) (Z Code) Name: Phone: Email address: Address: (Street) (City) (State) (Z Code) YOU MUST IMMEDIATELY NOTIFY THE COURT, IN WRITING, OF ANY CHANGE IN THE ABOVE INFORMATION. I swear or affirm, under the penalties of perjury, that I have examined the Guardian/Conservator General Information, and to the best of my knowledge and belief, it is true, correct and complete. Date Signature Name Bar Number and Firm Name (attorneys only) Street Address/P.O. Box City/State/ZIP Code Phone E-mail Address American LegalNet, Inc. www.FormsWorkFlow.com