Fill and Sign the No Court Proceeding is Pending in This State Form

JDF 861SC R 6/1 9 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 1 of 7  District Court  Denver Probate Court ___________________ County, Colorado Court Address: In the Interest of: Minor 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 FOR APPOINTMENT OF CONSERVATOR FOR MINOR 1.  No court proceeding is pending in this state or elsewhere concerning the respondent.  The following proceeding(s) concern(s) the respondent. Identify name of court, case number, state, date, and type of proceeding if any. Name of Court Case Number State Date of Proceeding Type of Proceeding 2. The petitioner is:  a person who would be ad versely affected by lack of effective management of the m inor’s property and business.  a person who is interested in the estate, financial affairs, or welfare of the m inor.  the minor and is 12 years of age or older. This is a p etition for appointment of a :  C onservator . (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 m inor’s property as may be required for the support of the m inor or in dividuals who are dependent upon the M inor.  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. 3. Information about the p etitioner: Name: List all names used (also known as, formerly known as, etc.): __________________________________________ Relationship to Minor: Street Address: City: _________________ State: _________ Zip Code: __________________________ JDF 861SC R 6/1 9 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 2 of 7 Mailing Address, if different: City: State: Zip Code: Prim ary Phone: __________________ Alternate P hone: ___________________________ Email Address: Does Petitioner need an interpreter?  No  Yes (Language:______________________________) 4. Information about the m inor: Name: A ge: Date of Birth: Street Address : City: __________________ State: _________ Zip Code: ___________________________ Mailing Address, if different: City: State: Zip Code: Prim ary Phone: _____________ ____________________ Alternate P hone: __________________ Email address: Does the m inor need an interpreter?  No  Yes (Language:______________________________) 5. Information about the m inor’s parents: Parent ’s Name:  Deceased  Unknown (attach Birth Certificate) Street Address : City: __________________ State: _________ Zip Code: ___________________________ Mailing Address, if different: City: State: Zip Code: Prim ary P hone: ________________________ Alternate P hone: ___________________________ Email Address: Does this person need an interpreter?  No  Yes (Language:______________________________) Parent ’s Name:  Deceased  Unknown (attach Birth Certificate) Street Address : City: __________________ State: _________ Zip Code: ___________________________ Mailing Address, if different: City: State: Zip Code: Prim ary P hone: ________ ____________________ Alternate P hone: ___________________________ Email Address: Does this person need an interpreter?  No  Yes (Language:______________________________) 6. Venue for this proceeding is proper in this county because the m inor  resides in this county.  does not reside in this state but has property in this county. JDF 861SC R 6/1 9 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 3 of 7 7.  A conservator is required because of the minor ’s age. The m inor  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. 8.  A conservator is required for reasons other than the minor’s age. The minor is unable to manage property and business affairs because he or 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 le tter 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. 9.  A conservator is required because the m inor is missing, detained, or unable to return to the United States. The nature of the m inor’s disappearance or detention and any efforts to locate the minor are as follows: 10. 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 c onservator’s powers and duties, if any, are as follows: 11. The petitioner requests the special conservator’s powers and duties be  unlimited or unrestricted or  limited or with restrictions . The property to be placed under the special c onservator’s control and the requested limitations /restrictions on the Special Conservator’s powers and duties, if any, are as follows: JDF 861SC R 6/1 9 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 4 of 7 12.  Petitioner is 21 years of age or older , nominates himself or herself and requests to be appointed as c onservator 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: List all names used (also known as, formerly known as, etc.): __________________________________________ Relationship to Minor: Street Address: City: _____________________ State: ________________ Zip Code: _____________________ Mailing Address, if different: City: State: Zip Code: Primary phone: _____________________ Alternate phone: _____________________________ Email Address: Does this person need an interpreter?  No  Yes (Language:______________________________) 13. The nominated c onservator has priority for appointment because he or she is:  nominated by the minor and the minor is 12 years of age or older. (Attach Consent or Nomination of Minor - JDF 82 6).  an interested person. (State nature of interest.) 14. 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 p etition. * JDF 861SC R 6/1 9 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 5 of 7  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.) 1 5. 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 p etition. *  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.) 16. 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 m inor, together with an estimate of the value . a. The minor ’s assets are: Description of Assets (e.g. bank accounts, property)  None. Estimated Value $ $ $ Total $ b. T he Minor ’s income is : Description of Income (e.g. social security, insurance or pension )  None. Estimated Amount of Income $ $ $ Total $ 17.  The following person is currently acting as Guardian or Conservator for the Minor in Colorado or elsewhere: Name: Relationship to Minor: Street Address: City: ________________ State: _________________ Zip Code: ___________________________ Mailing Address, if different: City: State: Zip Code: JDF 861SC R 6/1 9 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 6 of 7 Prim ary Phone: _________ ____________________ Alternate P hone: ______________________ Email Address: Does this person need an interpreter?  No  Yes (Language:______________________________) 18.  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: City: ___________________ State: ___________ Zip Code: ___________________ Mailing Address, if different: City: State: Zip Code: Prim ary Phone: ________________________ Alternate P hone: ________________________ Email Address: Does this person need an interpreter?  No  Yes (Language:______________________________) 19. The following person had the primary care and custody of the minor during t he 60 days prior to the filing of this petition : Name: Relationship to Minor: Street Address: City: ____________________ State: ________________________ Zip Code: __________________ Mailing Address, if different: City: State: Zip Code: Prim ary P hone: _____ ____________________ Alternate P hone: _______________________ Email Address: Dates of Care: Does this person need an interpreter?  No  Yes (Language:______________________________) 20.  The following person is a legal representative for the m inor not otherwise designated above. ( Representative payee, trustee, custodian of a trust, etc. § 15-14-102(6), C.R.S.) Name: Type of Legal Representative: Street Address: ___________________________________________________________ City: __________________ State: ________________ Zip Code: _____________________ Mailing Address , if different: C ity: State: Zip Code: Prim ary P hone: ____________________ Alternate P hone: ___________________________ Email Address: 21. The Petitioner requests than an appointment of a Conservator be made after notice and hearing . JDF 861SC R 6/1 9 PETITION FOR APPOINTMENT OF CONSERVATOR FOR MINOR Page 7 of 7  In addition, the Petitioner request s 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. 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