Fill and Sign the Years of Age and Born on Form

JDF 821SC R6/1 9 AFFIDAVIT OF ACCEPTANCE OF APPOINTMENT BY WRITTEN INSTRUMENT AS GUARDIAN FOR MINOR Page 1 of 3  District Court  Denver Probate Court _________________________________ County, Colorado Court Address: I n 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 AFFIDAVIT OF ACCEPTANCE OF APPOINTMENT BY WRITTEN INSTRUMENT AS GUARDIAN FOR MINOR PURSUANT TO § 15 -14 -202, C.R.S. I, ( g uardian) , accept the appointment of g uardian for the above named unmarried minor who is years of age and born on (date) . 1. Information about the a ppointed guardian : Name: Relationship to Minor : Street Address : City: State: Zip Code: Mailing Address : City: State: Zip Code: Prim ary Phone: Alternate Phone: Email Address: 2. The appointment was made by  will or  other signed writing by ___________________________(the m inor’s parent ) on ____ _______________ (date) : Appointment by w ill:  Certified copy of will is attached. o r  Filed in this court on (date) in the following case number: o r  Filed in (County ) in (State) in the following case number: . Appointment by other signed writing:  Original signed writing is attached and is signed by the parent or guardian. JDF 821SC R6/1 9 AFFIDAVIT OF ACCEPTANCE OF APPOINTMENT BY WRITTEN INSTRUMENT AS GUARDIAN FOR MINOR Page 2 of 3 3. The parents of the m inor are and .  both parents are deceased.  (Name) was the last parent to die and at that time was a resident of ______________________________________ (name of County and State) .  (Name) is de ceased and (name) survives, but has been adjud icated incapacitated and order is attached.  both parents are alive and have been adjudicated incapacitated. Attach orders adjudicating incapacity. 4. No other g uardian for the m inor has been appointed. 5. I submit personally to the jurisdiction of this court in any proceeding relating to this guardianship that may be instituted by any interested person. Notice of any such proceeding may be mailed to me by ordinary mail at my address stated above, or at suc h other address as I may later report to the c ourt.  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 ___________, _________, (date) (month) (year) at ______________________________________ (city or other location, and state OR country) _______________________________ (printed name) _______________________________ (signature) C ERTIFICATE OF SERVICE I certify that on ___________________ (date), a copy of this _______________ (name of document) was served as follows on each of the following: Name and Address Relationship to Decedent, Ward, or Protected Person Manner of Service* JDF 821SC R6/1 9 AFFIDAVIT OF ACCEPTANCE OF APPOINTMENT BY WRITTEN INSTRUMENT AS GUARDIAN FOR MINOR Page 3 of 3 *Insert one of the following: hand delivery, first -class mail, certified mail, e -service, or fax. ______________________________________ Signature Note: • Notice of this Affidavit of Acceptance of Appointment must be given to the appointin g parent or guardian, if living ; the minor, if he or she is 12 years of age or older ; and a person other than the parent or g uardian having care and custody of the m inor. • Any person receiving this a ffidavit may cause this appointment to terminate by filing a written objection to this appointment within 35 days after receipt of the a ffidavit. However, filing of an objection will not preclude the appointment of this or another suitable guardian by the c ourt in a proper proceeding. • The minor, if 12 years of age or older, can consent or refuse to consent to the appointment of the g uardian within 35 days after receipt of the affidavit . The Verified Consent of Minor (JDF 826) must be filed with the court .