Fill and Sign the Colorado Conservator Manual Form

JDF 783 SC R6/19 PETITION REQUESTING COL ORADO TO ACCEPT GUARDIANSHIP/CONSERVATORSHIP Page 1 of 2 ❑ District Court ❑ Denver Probate Court ___________________ County, Colorado Court Address: In the Interest of: Ward/ Protected Person COURT USE ONLY Attorney or Party W ithout Attorney (Name and Address): Phone Number: E -mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION REQUESTING COLORADO TO ACCEPT ❑ GUARDIANSHIP ❑ CONSERVATORSHIP FROM SENDING STATE This petition is submitted pursuant to § 15 -14.5 -302, C.R.S. of the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act. The guardian and/or conservator petitioner , hereby submit s certified c op ies of any documents evidencing authority to act ( Order of Appointment , Letters) and the Provisional Order of Transfer from the sending state relating to a ❑ Guardianship ❑ Conservatorship , as identified below: Sending State: Sending Court: Sending Court Case #: 1. Information about the guardian and/or conservator : Name: Street Address: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary Phone: Alternate Phone: Email Address: 2. Information about the ward/ protected person: Name: Street Address: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary Phone: Alternate Phone: Email Address: Type of Residence: ❑ Private ❑ Nursing Home ❑ Assisted Living Home ❑ Other: ____________________ 3. The petitioner requests that Colorado accept this guardianship/ conservatorship for the following reasons: JDF 783 SC R6/19 PETITION REQUESTING COL ORADO TO ACCEPT GUARDIANSHIP/CONSERVATORSHIP Page 2 of 2 4. The petitioner must provide this petition and a Notice of Hearing Without Appearance (JDF 712) to persons entitled to notice. (§ 15-14.5 -302(2), C.R.S.) 5. The interested persons given notice are as follows: Name of Interested Person Requiring Notice in Sending State Relationship to Ward/ Protected Person Name of Interested Person Requiring Notice in Colorado , not listed above Relationship to Ward/ Protected Person ❑ 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. VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the ______ day of Executed on the ______ day of (date) (date) _______________________, _________, _______________________, _________, (month) (year) (month) (year) at ______________________________________ at ______________________________________ (city or other location, and state OR country) (city or other location, and state OR country) _______________________________ _______________________________ (printed name) (printed name) _______________________________ _______________________________ (Signature of Petitioner) (Signature of Co -Petitioner, if any) ____________________________________________ __________________ Attorney Signature, (if any) Date