Acknowledgement Of Conservator And Lawyers Undertaking And Obligation {PBC83f}

Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: Lawyer's Bar Number: Licensed Fiduciary Number: ____________________________________ Representing Self, without a Lawyer or Attorney for Petitioner OR FOR CLERK'S USE ONLY Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY In the Matter of the Conservatorship of: Case No. PB ACKNOWLEDGEMENT OF CONSERVATOR and LAWYER'S UNDERTAKING AND OBLIGATION Name of the Protected Adult or Minor I, (Conservator's Name) , having been appointed by the Superior Court of Arizona in Maricopa County as Conservator for the protected person named above, hereby authorize (Attorney's Name) to deposit all of the net conservatorship assets, in the amount of $ The assets will be deposited in a restricted account in my name as the Conservator for: . (Name of the Protected Adult or Minor) · This shall be a restricted account. · No withdrawals of principal or interest will be permitted except by certified order of the Superior Court of Arizona in Maricopa County. © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED PBC83f - 050115 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case No. · Reinvestments may be made without an order of the Court as long as each account remains restricted and at the same financial institution. Date Conservator's Signature Printed Name STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: (date) by . (notary seal) Deputy Clerk or Notary Public LAWYER'S UNDERTAKING AND OBLIGATION I, as an officer of this Court and as the attorney for (Conservator's Name) in this person's capacity as the conservator for (Protected Person's Name) , hereby assume and undertake personal responsibility to the protected person and to the Court to make the above designated restricted deposit and to deliver to the Court a completed Proof of Restricted Account form evidencing the restricted deposit and the amount thereof within thirty (30) days from this date or to refund all of the funds to the Court immediately upon demand. Date: (Attorney's Signature) (Attorney's Printed Name) © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED PBC83f - 050115 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com