State of Minnesota
District Court
Probate Division
County of ____________________
Judicial District: __________________
Court File No. _____________________
Case Type: 14, Conservatorship
In Re: Conservatorship of
AFFIDAVIT IN SUPPORT OF PETITION TO
____________________________,
SELL REAL PROPERTY
Protected Person
STATE OF MINNESOTA
)
) SS
COUNTY OF
)
The undersigned, ______________________, hereby states and alleges as follows:
1. That affiant is the duly appointed conservator of the estate of above-referenced
protected person, appointed on _______________________.
2. That the conservator has been and will be responsible for the administration of the
conservatorship.
3. That during the time the conservator has been involved in the administration of the
conservatorship, the conservator has had an opportunity to review the assets and outstanding
bills, has visited the protected person, and has secured and protected the house located at
__________________________________________________________________________.
4. That the protected person currently resides at ____________________________.
5. That the income of the conservatorship consists of ___________ in the amount of
$_______ per month and income from ____________ in the amount of $__________ per month
and from __________ in the amount of $________ per month.
6. That the assets of the conservatorship consist of an interest in the _______ County
real estate with an assessed market value of $____________, and the personal property as listed
in the inventory of the conservator in the amount of $_________________.
GAC 21-UA
State
ENG
Rev 7/15
www.mncourts.gov/forms
Page 1 of 2
State of Minnesota
District Court
Probate Division
County of ____________________
Judicial District: __________________
Court File No. _____________________
Case Type: 14, Conservatorship
In Re: Conservatorship of
AFFIDAVIT IN SUPPORT OF PETITION TO
____________________________,
SELL REAL PROPERTY
Protected Person
STATE OF MINNESOTA
)
) SS
COUNTY OF
)
The undersigned, ______________________, hereby states and alleges as follows:
1. That affiant is the duly appointed conservator of the estate of above-referenced
protected person, appointed on _______________________.
2. That the conservator has been and will be responsible for the administration of the
conservatorship.
3. That during the time the conservator has been involved in the administration of the
conservatorship, the conservator has had an opportunity to review the assets and outstanding
bills, has visited the protected person, and has secured and protected the house located at
__________________________________________________________________________.
4. That the protected person currently resides at ____________________________.
5. That the income of the conservatorship consists of ___________ in the amount of
$_______ per month and income from ____________ in the amount of $__________ per month
and from __________ in the amount of $________ per month.
6. That the assets of the conservatorship consist of an interest in the _______ County
real estate with an assessed market value of $____________, and the personal property as listed
in the inventory of the conservator in the amount of $_________________.
GAC 21-UA
State
ENG
Rev 7/15
www.mncourts.gov/forms
Page 1 of 2
7. That the real estate taxes, utilities, and insurance expenses in connection with the
properties are in excess of $___________ per year.
8. That the homestead should be sold for the following reasons:
a.
The property is earning no income;
b.
The protected person is not in need of the house for the protected person’s
residence;
c.
The protected person is not able to return to independent living;
d.
By selling the property the conservator would increase the income of the
conservatorship;
e.
The Department of Economic Assistance requires the property to be sold in
order for the conservatee to be eligible for Medical Assistance benefits; and
f.
It is in the best interest of the protected person.
I declare under penalty of perjury that everything I have stated in this document is true and
correct. Minn. Stat. § 358.116.
FURTHER YOUR AFFIANT SAYETH NOT.
Dated:________________
__________________________________
Petitioner / Affiant
Name of Petitioner’s Attorney:
Name:
License No.
Address:
City/State/Zip:
E-mail address
GAC 21-UA
State
ENG
Rev 7/15
www.mncourts.gov/forms
Page 2 of 2
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