Fill and Sign the Conservator Form

 District Court  Denver Probate Court ___________________ County, Colorado Court Address: In the Interest of: Minor COURT USE ONLY Attorney or Party Without Attorney (name and address): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR 1. The Petitioner is:  a person who would be adversely affected by lack of effective management of the Minor’s property and business.  a person who is interested in the estate, financial affairs, or welfare of the Minor.  the Minor and is 12 years of age or older. This is a Petition for appointment of a:  Conservator. (Note: the appointment will expire when the Minor reaches the age of 21, unless otherwise ordered by the Court.)  Special Conservator. While a petition to establish a conservatorship is pending, a Special Conservator is needed to preserve and apply the Minor’s property as may be required for the support of the Minor or individuals who are dependent upon the Minor.  Special Conservator. A Special Conservator is necessary to assist in the accomplishment of the following protective arrangement or other single transaction. A permanent conservatorship is not requested. 2. Information about the Petitioner: Name: Relationship to Minor: Street Address: Mailing Address, if different: City: State: Zip Code: Home Phone #: Email Address: Work Phone #: Does Petitioner need an interpreter?:  No  Yes (Language:______________________________) 3. Information about the Minor: JDF 861 R8/17 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 1 of 6 ©2017 Colorado Judicial Department for use in the Courts of Colorado Name: Age: Date of Birth: Street Address: Mailing Address, if different: City: State: Zip Code: Home Phone #: Email Address: Work Phone #: Does the Minor need an interpreter?:  No  Yes (Language:______________________________) 4. Information about the Minor’s parents: Parent’s Name:  Deceased  Unknown (attach Birth Certificate) Street Address: Mailing Address, if different: City: State: Zip Code: Home Phone # Email Address: Work Phone #: Does this person need an interpreter?:  No  Yes (Language:______________________________) Parent’s Name:  Deceased  Unknown (attach Birth Certificate) Street Address: Mailing Address, if different: City: State: Zip Code: Home Phone # Email Address: Work Phone #: Does this person need an interpreter?:  No  Yes (Language:______________________________) 5. Venue for this proceeding is proper in this county because the Minor  resides in this county.  does not reside in this state, but has property in this county. 6.  A conservator is required because of the Minor’s age. The Minor  owns or will receive money or property that requires management or protection that cannot otherwise be provided; and/or  has or may have business affairs that may be put at risk or prevented because of his or her age; and/or  needs money for support and education and protection is necessary or desirable to obtain or provide money. JDF 861 R8/17 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 2 of 6 ©2017 Colorado Judicial Department for use in the Courts of Colorado 7.  A conservator is required for reasons other than the Minor’s age. The Minor is unable to manage property and business affairs because he/she is unable to effectively receive and evaluate information or both or to make or communicate decisions, even with the use of appropriate and reasonably available technological assistance due to the following disabilities or impairments:  Physician’s letter attached.  In addition:  the Minor has property that will be wasted or dissipated unless proper management is provided. and/or  the Minor, or persons entitled to the Minor’s support, require money for support, care, education, health, and welfare, and protection is necessary or desirable to obtain or provide money. 8.  A Conservator is required because the Minor is missing, detained, or unable to return to the United States. The nature of the Minor’s disappearance or detention and any efforts to locate the Minor are as follows: 9. The Petitioner requests the Conservator’s powers and duties be  unlimited/unrestricted or  limited/with restrictions. The property to be placed under the Conservator’s control and the requested limitations/restrictions on the Conservator’s powers and duties, if any, are as follows: 10.  Petitioner is 21 years of age or older, nominates himself/herself and requests to be appointed as Conservator or Special Conservator. or  Petitioner nominates the following person, who is 21 years of age or older, to be appointed as Conservator or Special Conservator. Name: Relationship to Minor: Street Address: Mailing Address, if different: JDF 861 R8/17 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 3 of 6 ©2017 Colorado Judicial Department for use in the Courts of Colorado City: State: Zip Code: Home Phone #: Email Address: Work Phone #: Does this person need an interpreter?:  No  Yes (Language:______________________________) 11. The nominated Conservator has priority for appointment because he/she is:  nominated by the Minor and the Minor is 12 years of age or older. (A ttach Consent or Nomination of Minor - JDF 826).  an interested person. (State nature of interest.) 12. The Conservator may receive compensation.  The hourly rates to be charged, any amounts to be charged pursuant to a published fee schedule, including the rates and basis for charging fees for any extraordinary services, and any other bases upon which a fee charged to the estate will be calculated, are as stated below or in an attachment to this Petition. *  The basis of compensation has not yet been determined. 13. The Conservator may compensate his, her, or its counsel.  The hourly rates to be charged, any amounts to be charged pursuant to a published fee schedule, including the rates and basis for charging fees for any extraordinary services, and any other bases upon which a fee charged to the estate will be calculated, are as stated below or in an attachment to this Petition. *  The basis of compensation has not yet been determined. * There is a continuing obligation to disclose any material changes to the basis for charging fees. (§ 15-10-602 C.R.S.) JDF 861 R8/17 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 4 of 6 ©2017 Colorado Judicial Department for use in the Courts of Colorado 14. Sections a and b below identify assets and the source and amount of estimated income (public benefits, real property, proceeds from insurance policy, proceeds from pension, etc.) of the Minor, together with an estimate of the value . a. The Minor’s assets are: Description of Assets (e.g. bank a ccounts, property)  None. Estimated Value $ $ $ Total $ b. The Minor’s income is: Description of Income (e.g. social security, insurance or pension)  None. Estimated Amount of Income $ $ $ Total $ 15.  The following person is currently acting as Guardian or Conservator for the Minor in Colorado or elsewhere: Name: Relationship to Minor: Street Address: Mailing Address, if different: City: State: Zip Code: Home Phone #: Email Address: Work Phone #: Does this person need an interpreter?:  No  Yes (Language:______________________________) 16.  The Minor’s parents are deceased. The following person is the adult relative nearest in kinship that can be found with reasonable efforts: Name: Relationship to Minor: Street Address: Mailing Address, if different: City: State: Zip Code: Home Phone #: Email Address: Work Phone #: JDF 861 R8/17 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 5 of 6 ©2017 Colorado Judicial Department for use in the Courts of Colorado Does this person need an interpreter?:  No  Yes (Language:______________________________) 17. The following person had the primary care and custody of the Minor during the 60 days prior to the filing of this Petition: Name: Relationship to Minor: Street Address: Mailing Address, if different: City: State: Zip Code: Home Phone #: Email Address: Work Phone #: Dates of Care: Does this person need an interpreter?:  No  Yes (Language:______________________________) 18.  The following person is a legal representative for the Minor not otherwise designated above. (Representative payee, trustee, custodian of a trust, etc. §15-14-102(6), C.R.S.) Name: Type of Legal Representative: Mailing Address: City: State: Zip Code: Email Address: Phone #: The Petitioner requests than an appointment of a Conservator be made after notice and hearing.  In addition, the Petitioner requests the following:  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. (Checking this box requires you to remove JDF number and copyright at the bottom of the form.) VERIFICATION AND ACKNOWLEDGMENT I (Petitioner) verify that the facts set forth in this document are true as far as I know or am informed. I understand that penalties for perjury follow deliberate falsification of the facts stated herein. (§15-10-310, C.R.S.) JDF 861 R8/17 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 6 of 6 ©2017 Colorado Judicial Department for use in the Courts of Colorado ____________________________________________ Signature of Petitioner Date The foregoing instrument was acknowledged before me in the County of ________________, State of Colorado, this ____day of ____________, 20___, by the Petitioner. My Commission Expires: ________________ _____________________________________________ Notary Public/Deputy Clerk ______________________________________ Signature of Attorney Date JDF 861 R8/17 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 7 of 6 ©2017 Colorado Judicial Department for use in the Courts of Colorado