Fill and Sign the Financial Plan Colorado Form

 District Court  Denver Probate Court ___________________________________ County, Colorado Court 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 1 of 4 This form conforms in substance to CPC 29-FP. I. Current Assets Description of the Asset Market Value of the Asset Investments: _________________________ $______________________________ Real Estate: _________________________ $ ______________________________ Savings: _____________________________ $ ______________________________ Checking: ____________________________ $_______________________________ Other: _______________________________ $_______________________________ Other: _______________________________ $_______________________________ Other: _______________________________ $_______________________________ Total Market Value $_______________________________ II. Liabilities Description of the Liability Current Amount of Liability ___________________________________ $______________________________ ___________________________________ $______________________________ ___________________________________ $______________________________ ___________________________________ $______________________________ ___________________________________ $______________________________ Total Liabilities $______________________________ III. Income (List all sources of Income.) Description of Income Amount of Income Social 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 2 of 4 This 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. Claims Are there claims on behalf of the protected person to be pursued? If so, please explain. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Will litigation be necessary? If so, please explain. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ VII. Debts Are there bills, claims, or debts unpaid at this time? If so, how do you intend to discharge those obligations? __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ VIII. Encouraging Self-Reliance and Independence What 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 3 of 4 This 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 Aspects Are there any other aspects of the financial plan not covered by this outline? If so, please explain. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Dated: _________________________________ _____________________________________ Signature of Conservator CPC 29-FP R7/03 FINANCIAL PLAN Page 4 of 4 This form conforms in substance to CPC 29-FP.