Restricted Account Report {JDF 896}

JDF 805SC R6/19 ACCEPTANCE OF OFFICE Page 1 of 3 1. I, (name), accept appointment to, and agree to perform the duties and discharge the trust of, the office of (check all that apply): Guardian. Emergency guardian. Temporary guardian. Conservator. Special conservator. 2. I submit personally to the jurisdiction of this court in any proceeding relating to this matter. 3. A legible copy of my driver222s license, passport, or other government-issued identification is filed/e-filed as a separate document. 4. I request that the court waive required background information because I am (if this paragraph applies, check all boxes below that apply, and skip questions 5 through 9) : a public administrator. a trust company, bank, credit union, savings and loan, or other financial institution. a state or county agency. the respondent222s parent, and I reside with the respondent. a person or entity for whom good cause exists to waive such disclosures. State reasons of good cause: The court may require a nominee to obtain additional background information that the court considers necessary to assist it in determining the fitness of the nominee for the appointment sought. Such information may include requiring a nominee to obtain fingerprint-based criminal history record checks through the Colorado Bureau of Investigation and the Federal Bureau of Investigation at the nominee222s expense. (247 15-14-110(5), C.R.S.) District Court Denver Probate Court County, Colorado Court Address: In the Interest of: Respondent COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom ACCEPTANCE OF OFFICE 226 GUARDIANSHIPS AND CONSERVATORSHIPS American LegalNet, Inc. www.FormsWorkFlow.com JDF 805SC R6/19 ACCEPTANCE OF OFFICE Page 2 of 3 5. I have have not been convicted of, pled no contest to, or received a deferred sentence for one or more felonies or misdemeanors. If so, describe all: Name of State and Court Issuing Order 6. I have have not had a temporary or permanent civil restraining/protection order issued against me. If so, describe all: Name of State and Court Issuing Order 7. A civil judgment has has not been entered against me. If so, describe all: Name of State and Court Entering Judgment 8. I have have not been relieved from one or more court-appointed responsibilities. If so, describe all: Name of State and Court Relieving Nominee 9. Copies of my name-based criminal history record check obtained through the Colorado Bureau of Investigation and my current credit report are filed/e-filed as separate documents. (See instructions below.) 10. I am am not a 223professional224 which is defined as: an individual or entity engaged in the business of providing services as guardian or conservator, who is not related to the respondent by blood, law, or marriage. A professional usually acts as guardian or conservator for two or more individuals. 11. The nominee acknowledges and understands that if the nominee fails to file required reports or plans with the court or fails to respond to an order of the court to show cause why the nominee should not be held in contempt of court, Colorado law authorizes the court to access data and records of state agencies in order to obtain contact information, as defined in 24724715-14-317(4)(c) and 15-14-420(6)(c), C.R.S. Note: Social security numbers should not be attached to or written on this Acceptance of Office. By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. American LegalNet, Inc. www.FormsWorkFlow.com JDF 805SC R6/19 ACCEPTANCE OF OFFICE Page 3 of 3 VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the day of , , (date) (month) (year) at (city or other location, and state OR country) (printed name) (signature) Notes To obtain a name-based criminal history check from the Colorado Bureau of Investigation (CBI), contact CBI: 690 Kipling Street, Suite 315, Lakewood, CO 80215; (303) 239-4208; or at www.colorado.gov/cbi. For online search requests: go to www.cbirecordscheck.com . The cost may be less and response time may be faster than written request. Credit card payment is required. To obtain a current credit report, contact any of the following credit reporting agencies: a) Equifax Credit Information Services, Inc.; P.O. Box 740241, Atlanta, GA 30374; 1-800-685-1111; or www.equifax.com ; b) Experian; 1-888-397-3742; or www.experian.com ; or c) TransUnion, Annual Credit Report Request Service; P.O. Box 105281, Atlanta, GA 30348; 1-877-322-8228; or www.transunion.com . 247 15-14-110, C.R.S., requires that the costs for all criminal history checks and credit reports be paid by the proposed guardian/conservator. 247 15-14-110(5)(b), C.R.S., requires the court to order the nominee to submit to a name-based criminal history record check, as defined in 247 22-2-119.3(6)(d), when the results of a fingerprint-based criminal record check reveal the nominee has a record of arrest without a disposition. American LegalNet, Inc. www.FormsWorkFlow.com