Fill and Sign the I Name Accept Appointment to and Agree to Perform the Duties and

District Court Denver Probate Court ___________________ County, Colorado Court Address: In the Interest of: Respondent Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number: Phone Number: E-mail: FAX Number: Atty. Reg. #: Division Courtroom ACCEPTANCE OF OFFICE – GUARDIANSHIPS AND CONSERVATORSHIPS 1. I, __________________ (name), accept appointment to, and agree to perform the duties and discharge the trust of, the office of (check all that apply): Guardian. Emergency guardian. Temporary guardian. Conservator. Special conservator. 2. I submit personally to the jurisdiction of this court in any proceeding relating to this matter. 3. A legible copy of my driver’s license, passport, or other government-issued identification is filed/efiled as a separate document. 4. I request that the court waive required background information because I am (if this paragraph applies, check all boxes below that apply, and skip questions 5 through 9) : a public administrator. a trust company, bank, credit union, savings and loan, or other financial institution. a state or county agency. the respondent’s parent, and I reside with the respondent. a person or entity for whom good cause exists to waive such disclosures. State reasons of good cause: ________________________________________________________________________ The court may require a nominee to obtain additional background information that the court considers necessary to assist it in determining the fitness of the nominee for the appointment sought. Such information may include requiring a nominee to obtain fingerprint-based criminal history record checks through the Colorado Bureau of Investigation and the Federal Bureau of Investigation at the nominee’s expense. (§ 15-14-110(5), C.R.S.) JDF 805SC R6/19 ACCEPTANCE OF OFFICE Page 1 of 3 5. 6. 7. 8. 9. 10. 11. I  have  have not been convicted of, pled no contest to, or received a deferred sentence for one or more felonies or misdemeanors. If so, describe all: Name of State and Court Issuing Order I  have  have not had a temporary or permanent civil restraining/protection order issued against me. If so, describe all: Name of State and Court Issuing Order A civil judgment  has  has not been entered against me. If so, describe all: Name of State and Court Entering Judgment I  have have not been relieved from one or more court-appointed responsibilities. If so, describe all: Name of State and Court Relieving Nominee Copies of my name-based criminal history record check obtained through the Colorado Bureau of Investigation and my current credit report are filed/e-filed as separate documents. (See instructions below.) I  am  am not a “professional” which is defined as: an individual or entity engaged in the business of providing services as guardian or conservator, who is not related to the respondent by blood, law, or marriage. A professional usually acts as guardian or conservator for two or more individuals. The nominee acknowledges and understands that if the nominee fails to file required reports or plans with the court or fails to respond to an order of the court to show cause why the nominee should not be held in contempt of court, Colorado law authorizes the court to access data and records of state agencies in order to obtain contact information, as defined in §§15-14-317(4)(c) and 15-14-420(6)(c), C.R.S. Note: Social security numbers should not be attached to or written on this Acceptance of Office.  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. JDF 805SC R6/19 ACCEPTANCE OF OFFICE Page 2 of 3 VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the ______ day of ___________, _________, (date) (month) (year) at ______________________________________ (city or other location, and state OR country) _______________________________ (printed name) _______________________________ (signature) Notes • To obtain a name-based criminal history check from the Colorado Bureau of Investigation (CBI), contact CBI: 690 Kipling Street, Suite 315, Lakewood, CO 80215; (303) 239-4208; or at www.colorado.gov/cbi. For online search requests: go to www.cbirecordscheck.com. The cost may be less and response time may be faster than written request. Credit card payment is required. • To obtain a current credit report, contact any of the following credit reporting agencies: a) Equifax Credit Information Services, Inc.; P.O. Box 740241, Atlanta, GA 30374; 1800-685-1111; or www.equifax.com ; b) Experian; 1-888-397-3742; or www.experian.com ; or c) TransUnion, Annual Credit Report Request Service; P.O. Box 105281, Atlanta, GA 30348; 1-877-322-8228; or www.transunion.com . • § 15-14-110, C.R.S., requires that the costs for all criminal history checks and credit reports be paid by the proposed guardian/conservator. • § 15-14-110(5)(b), C.R.S., requires the court to order the nominee to submit to a name-based criminal history record check, as defined in § 22-2-119.3(6)(d), when the results of a fingerprintbased criminal record check reveal the nominee has a record of arrest without a disposition. 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