Form CC 16:2.216 Acceptance of Appointment of Guardian and Conservator by the Public Guardian - Nebraska

Form CC16:2.216 is a Nebraska Judicial Branch form also known as the "Acceptance Of Appointment Of Guardian And Conservator By The Public Guardian". The latest edition of the form was released in August 1, 2016 and is available for digital filing.

Download a PDF version of the Form CC16:2.216 down below or find it on Nebraska Judicial Branch Forms website.

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Nebraska State Court Form
ACCEPTANCE OF
REQUIRED
APPOINTMENT OF GUARDIAN
AND CONSERVATOR BY THE
CC 16:2.216 Rev. 08/16
PUBLIC GUARDIAN
Neb. Ct. R. § 6-1443(A)
IN THE COUNTY COURT OF
COUNTY, NEBRASKA
Case No.
IN THE MATTER OF
ACCEPTANCE OF APPOINTMENT OF
GUARDIAN AND CONSERVATOR BY
Ward/Incapacitated Person/Protected Person
THE PUBLIC GUARDIAN
The Public Guardian accepts the appointment as guardian and conservator of the assets of,
and swears that they will perform, according to law, all
ward/incapacitated person/protected person
duties as guardian and conservator.
The Public Guardian acknowledges the responsibilities as guardian and conservator by initialing all of the
following:
Acknowledgements before Letters are issued to establish the Public Guardian’s authority to
serve as guardian and conservator:
The Public Guardian shall file with the court an Address Information for Guardianships/
Conservatorships form (CC 16:2.5).
The General Information Form, unless waived by the court for good cause shown.
The Public Guardian shall file with the court the Public Guardian Notice of Designation of
Deputy Public Guardian and Associate Public Guardians form (CC 16:2.96).
The Public Guardian shall file with the court an updated Public Guardian Notice of
Designation of Deputy Public Guardian and Associate Public Guardians form (CC 16:2.96) if the designation
changes after the initial filing.
If funds are restricted by court order, within ten days of appointment, the Public Guardian
shall file with the court, a Proof of Restricted Account form (CC 16:2.11) and (confidential) Personal and
Financial Information for Guardianships and Conservatorships form (CC 16:2.23) with full account numbers.
Within 30 days of appointment, the Public Guardian shall file with the court, an
Acknowledgement of Financial Institution form (CC 16:2.6) showing they gave copies of the order
appointing them conservator, to all financial institutions where the protected person has accounts. They
shall also file a (confidential) Personal and Financial Information for Guardianships and Conservatorships
Page 1 of 3
Acceptance of Appointment of Guardian
and Conservator by the Public Guardian
CC 16:2.216 Rev. 08/16
Nebraska State Court Form
ACCEPTANCE OF
REQUIRED
APPOINTMENT OF GUARDIAN
AND CONSERVATOR BY THE
CC 16:2.216 Rev. 08/16
PUBLIC GUARDIAN
Neb. Ct. R. § 6-1443(A)
IN THE COUNTY COURT OF
COUNTY, NEBRASKA
Case No.
IN THE MATTER OF
ACCEPTANCE OF APPOINTMENT OF
GUARDIAN AND CONSERVATOR BY
Ward/Incapacitated Person/Protected Person
THE PUBLIC GUARDIAN
The Public Guardian accepts the appointment as guardian and conservator of the assets of,
and swears that they will perform, according to law, all
ward/incapacitated person/protected person
duties as guardian and conservator.
The Public Guardian acknowledges the responsibilities as guardian and conservator by initialing all of the
following:
Acknowledgements before Letters are issued to establish the Public Guardian’s authority to
serve as guardian and conservator:
The Public Guardian shall file with the court an Address Information for Guardianships/
Conservatorships form (CC 16:2.5).
The General Information Form, unless waived by the court for good cause shown.
The Public Guardian shall file with the court the Public Guardian Notice of Designation of
Deputy Public Guardian and Associate Public Guardians form (CC 16:2.96).
The Public Guardian shall file with the court an updated Public Guardian Notice of
Designation of Deputy Public Guardian and Associate Public Guardians form (CC 16:2.96) if the designation
changes after the initial filing.
If funds are restricted by court order, within ten days of appointment, the Public Guardian
shall file with the court, a Proof of Restricted Account form (CC 16:2.11) and (confidential) Personal and
Financial Information for Guardianships and Conservatorships form (CC 16:2.23) with full account numbers.
Within 30 days of appointment, the Public Guardian shall file with the court, an
Acknowledgement of Financial Institution form (CC 16:2.6) showing they gave copies of the order
appointing them conservator, to all financial institutions where the protected person has accounts. They
shall also file a (confidential) Personal and Financial Information for Guardianships and Conservatorships
Page 1 of 3
Acceptance of Appointment of Guardian
and Conservator by the Public Guardian
CC 16:2.216 Rev. 08/16
form (CC 16:2.23) with full account numbers and printouts of all assets and account numbers.
Within 30 days of appointment, the Public Guardian shall file with the court a Budget
that pursuant to Neb. Ct. Rule § 6-1433.02(D) is for informational purposes only, and the Inventory,
Affidavit of Due Diligence, and Certificate of Mailing form (CC 16:2.9) of the ward’s/incapacitated
person’s assets.
Acknowledgements after Letters are issued:
The Public Guardian shall file with the court an Acknowledgement of Financial
Institution form (CC 16:2.6) showing that a copy of the Letters was given to all financial institutions
where the ward/incapacitated person/protected person has accounts. They shall also file with the court
a (confidential) Personal and Financial Information for Guardianships and Conservatorships form (CC
16:2.23) with full account numbers and printouts of all assets and account numbers.
The Public Guardian shall file the Letters of Guardianship and Conservatorship with the
Register of Deeds in any county where the ward/incapacitated person/protected person has real property
or an interest in real property.
One year after the appointment and every year thereafter, the Public Guardian shall file
with the court:
1. Annual Report of Guardian on Condition of Ward form (CC 16:2.14).
2. Updated Inventory form (CC 16:2.45).
3. Annual Accounting.
4. Certificate of Proof of Possession form (CC 16:2.13). If any funds are restricted, the bank or
depository must indicate a restriction to the account on the certificate: “No withdrawals without court
order.”
5. Copies of all individual ledger statements and/or brokerage statements for the dates covered by the
accounting. If full account numbers, social security numbers, dates of birth or other personal
information appear on the accounting statements and/or brokerage statements, all but the last four
digits shall be blacked out before sending them to the interested persons.
6. Personal and Financial Information for Guardianships and Conservatorships form (CC 16:2.23)
showing complete account numbers, etc. listed on Inventory and Certificate of Proof of Possession.
This form contains confidential information and is not shared with the parties except by court order.
Page 2 of 3
Acceptance of Appointment of Guardian and
Conservator by the Public Guardian
CC 16:2.216 Rev. 08/16
The Public Guardian acknowledges all of the documents, except the Personal and
Financial Information for Guardianships and Conservatorships form, shall be sent to all interested persons
along with Notice of Right to Object form (CC 16:2.16).
The Public Guardian acknowledges that a Certificate of Mailing (CC 16:2.24) shall be filed
with the court showing all of the documents to all interested persons have been mailed by first class mail,
postage pre-paid.
The Public Guardian shall notify the court of the change of address of the
ward/incapacitated person/protected person within three days of the change.
The Public Guardian shall not move the ward/incapacitated person/protected person to
a location outside of the State of Nebraska without court permission.
The Public Guardian shall notify the court of the ward’s/incapacitated person’s/protected
person’s death within three days.
The Public Guardian shall file with the court a Notice of Newly Discovered Assets form (CC
16:2.18) within 30 days after becoming aware of any additional assets, gifts, awards, settlements or
inheritances over $500.00 not disclosed in the most current inventory.
The Office of Public Guardian is prohibited from making ATM withdrawals or
receiving cash back on debit transactions.
Date
Signature
Print or Type Name
Bar Number and Firm Name (attorneys only)
Street Address/P.O. Box
City/State/ZIP Code
Phone of
E-mail Address
Page 3 of 3
Acceptance of Appointment of Guardian and
Conservator by the Public Guardian
CC 16:2.216 Rev. 08/16

Download Form CC 16:2.216 Acceptance of Appointment of Guardian and Conservator by the Public Guardian - Nebraska

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