Fill and Sign the Conservators Report Adult Minor Colorado Judicial Branch Form

CPC 29-FP R7/03 FINANCIAL PLAN Page 1 of 4This form conforms in substance to CPC 29-FP. District Court  Denver Probate Court___________________________________ County, ColoradoCourt Address:IN THE MATTER OF THE ESTATE OF:Protected Person COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail:FAX Number: Atty. Reg. #:Case Number:Division Courtroom FINANCIAL PLAN CONSERVATOR’S INFORMATION:Conservator’s Name: ________________________________________________Home Address: ________________________________________________(including P.O. Box) ________________________________________________Telephone Number: (_______)________________________________________Work Address: ________________________________________________(including P.O. Box) ________________________________________________Telephone Number: (_______)________________________________________PROTECTED PERSON’S INFORMATION:Protected Person’s Name: ________________________________________________Current Address: ________________________________________________(include Name of Living ________________________________________________Center or Nursing Home) ________________________________________________Telephone Number: (_______)________________________________________This format is intended as a guide to conservators and their lawyers in preparing the financial plan required pursuant to §15-14-418, C.R.S. This outline is intended to be submitted with the inventory (CPC Form 20 & §15- 14-419) within ninety (90) days after the appointment of a conservator. A Notice of Filing, along with copies of the financial plan and the inventory, must given to the protected person and any others as directed by the Court, within ten (10) days of filing. (§15-14-404(4)). The financial plan should be amended whenever there is a substantial deviation from the existing financial plan. (§15-14-418(5)). The conservator’s report (§15-14-420) should be filed annually unless otherwise ordered. CPC 29-FP R7/03 FINANCIAL PLAN Page 2 of 4This form conforms in substance to CPC 29-FP.I. Current AssetsDescription of the Asset Market Value of the AssetInvestments: _________________________ $______________________________Real Estate: _________________________ $ ______________________________Savings: _____________________________ $ ______________________________Checking: ____________________________ $_______________________________Other: _______________________________ $_______________________________Other: _______________________________ $_______________________________Other: _______________________________ $_______________________________ Total Market Value$_______________________________ II. LiabilitiesDescription of the Liability Current Amount of Liability___________________________________ $_________________________________________________________________$_________________________________________________________________$_________________________________________________________________$_________________________________________________________________$______________________________ Total Liabilities $______________________________ III. Income (List all sources of Income.)Description of Income Amount of IncomeSocial Security: __________________________ $_____________________________Retirement: _____________________________ $_____________________________Other: _________________________________ $_____________________________Other: _________________________________ $_____________________________Other: _________________________________ $_____________________________Other: _________________________________ $_____________________________ Total Income $_____________________________ IV. Expenses (List all regular expenses.)Description of the Monthly Expense Amount of Monthly Expense____________________________________ $_________________________________________________________________$_________________________________________________________________$_________________________________________________________________$_________________________________________________________________$_________________________________________________________________$_________________________________________________________________$_________________________________________________________________$_________________________________________________________________$_________________________________________________________________$_____________________________Total Monthly Expenses $_____________________________ CPC 29-FP R7/03 FINANCIAL PLAN Page 3 of 4This form conforms in substance to CPC 29-FP.V.Liquidity In view of the needs of the protected person at this time, what assets will need to be sold, what assets (personal property) held in storage, and what assets retained?__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________VI. ClaimsAre there claims on behalf of the protected person to be pursued? If so, please explain.__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________Will litigation be necessary? If so, please explain.__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ VII. DebtsAre there bills, claims, or debts unpaid at this time? If so, how do you intend to discharge those obligations?__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________VIII. Encouraging Self-Reliance and IndependenceWhat aspects of the protected person’s financial affairs can that person continue to manage?__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________What steps will be taken to develop or restore the protected person’s ability to manage property?__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ CPC 29-FP R7/03 FINANCIAL PLAN Page 4 of 4This form conforms in substance to CPC 29-FP.What is the expected duration of this conservatorship and why?__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________IX. Problems / Concerns State your own concerns or issues in the matter of handling this conservatorship, including any areas in which you may need specific assistance or guidance from professional advisors or this Court.__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________X. Any Other AspectsAre there any other aspects of the financial plan not covered by this outline? If so, please explain.__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________Dated: _________________________________ _____________________________________Signature of Conservator