User`s Manual for Conservators in Colorado
Contents
1. a e Bn TN i L i j SS fo era ae aes aa s Ire 7 ee EEE J t en L pi 3 f ERNA E ORENA A l l i H i imeem tin nnn ae S i F f H ji Satan L 4 H i i f j i l l oe L l aes i ewes cs ae l Page 8of9 wn both dates inclusive to the best of my knowledge information and bel ief i tthis reportis subject to audit and verification am required to maintain supporting documentation for all receipts and disbursements iling statements from any professional The Court or any Interested Persons as sr Appointing Conservator may request copies at any time 3 S Date gt ho Signature of Co Conservator if applicable Certificate of Service certify that on ye 4 2 D8 Aas the ide was e filed filed with the Court and a copy of this roe lapel bu Ee I i Sans Gee aur A i i i i i fi j j i f tying Service to sport must be filed annually and served on the protected person pursuant to 15 14 ana interested persons pursuant to the Order Appointing Conservator unless otherwise ANNUAL FINAL REPORT Page 9of4 Conservator s Information Name Do you plan on receiving any fees for being the Conservator ClYe2. aoe Insert hand delivery first class U S Mail certified U S Mail E filed or Fax RHevests nature of Person Certifying Servi Note The inventory with Financial Pian must be served on the protected person pursuant to 15 14 404 4 C R S and interested persons pursuant to the Order Appointing Conservator unless otherwise ordered CONSERVATOR S INVENTORY WITH FINANCIAL PLAN Page 7 of 7
3. Deseri S Account Name of Financial yaiue on Last Last Day of Changein 5 Number Institution day of Current Amount of o Gasa Reporting _ _ Liability digits only Prior Period l Reportin l Poring Period or O Uinventory es eee ane Le ea ER 4 eee ee E State and Local Taxes Owed gt Other Liabil ities Debts J Have Fagin changed from the last day of the Prior Reporting Period or Inventory Lives MNo i Yes briefly explain the changes below Please include a description of any significant or unanticipated transactions 3 Net Worth Fair Market Value of Assets Minus Liabilities Debts _LastDayof LastDayof Prior Reporting Current Reporting Net Worth Period or inventory Period ts minus Liabilities Debts tem 1 Total minus Item re vey DO Sa poo Tot 226 918 31 023 Enter r these amounts on page 1 J R D I le CONSERVATOR S ANNUAL FINAL REPORT Page 4of9 Part Ill Receipts income and Disbursements Expenses initial Conservator s Report filed res LiNo If Yes use the amounts from the Inventory with i lan JD 882 to complete the column marked with an asterisk CY in tems 1 and 2 below If No use wn the prior Conservators Report filed to complete the column marked with an asterisk in items
4. Folal Amount of Total Amount of change m Receipts Income from Receipts moun or Prior Reporti Incomefor Receipt Peri T ing Current j Income SHOE oF Reporting Period A l Pai Financial Pian l E TDD Oe FETH Proceeds from Sales of Assets _ Rental Income Gifts from Others Disability Unemployment or Worker s fore lic ic Assistance 2 Other Receipts income Ph lease e list E amz 7300 nnn H Exe 4 1 i explain th changes below Please include a description of any significant or unanticipated lank Carr CANE There ums a lithe a a ea LA vY Va 2s ALE a ok T oo Q gr S Oo CONSERVATOR S ANNUAL FINAL REPORT Page 5 of 9 D isbursements Expenses Description of Disbursement Expense t egory Di Cat Prior Reporting Total Amount of Disbursement Expense for Current Reporting Period Disbursement Expense from Total Amount of Period or MFinancial Plan K Change in amount of Disbursement Expense s Paid 4 from ParttlV iene 10 07 1207 ted Person E ope Tae and Assessments 5 Repairs 4 and Maintenarice E Mome F Furnishings LE pod ale inns Ies ae pi
5. B Disbursements Expenses state under penalty of perjury that this is a true and complete Inventory with Financial Plan of this estate during the period shown both dates inclusive to the best of my knowledge information and belief understand that this report is subject to audit and verification Conservator s Signature Date Subscribed and affirmed or sworn to before me in the County of State of this day of 20 My Commission Expires Notary Public Clerk Co Conservator s Signature Date Subscribed and affirmed or sworn to before me in the County of State of this day of 20 My Commission Expires Notary Public Clerk Certificate of Service certify that on date the original was e filed filed with the Court and a copy of this Conservator s Inventory with Financial Plan was served on each of the following Name of Person You are Relationship to Address Sending this Document To Protected Interested Persons Person Manner of Service Insert hand delivery first class U S Mail certified U S Mail E filed or Fax Signature of Person Certifying Service Note The Inventory with Financial Plan must be served on the protected person pursuant to 15 14 404 4 C R S and interested persons pursuant to the Order Appointing Conservator unless otherwise ordered L D
6. al space is needed separate sheets may be used s been completed a supplemental inventory listing those additional item s shall be completed dicating lf additional items are discovered after the Cash on Hand Bank Checking Savings Certificate of Type of Account Account Balance pt or Health Accounts Name of Bank or last 4 Financial Institution digits None Only Homelown Bank Cheding 1234 eE l Erari E l Hometown Bank Ams 7 Sog H5S l l l l J l J l f pora tij f n t ea aN E i Total Hae s eS Stocks Bonds Mutual Funds Securities and Investment Accounts Number of Current Fent Valus CINone Shares or identify Account Number last 4 digits only N N Rich Quidd Stalls CIETA RE E EAE ENO ES nr re a SE A 5 i l i k R l Total Sop 00 2 i f Life Insurance Name of Company Beneficiary Type of Policy Face Amount Cash Value None of Policy g Core Gr Lile Trewonw lo Term E o n i i a nes 2 chilaven T i EA EA A E E A oe Fetal 2s S 9 00 Pensi Profit Sharing Annuities or Retirement Type of Plan Account Current Value e Funds 404 k IRA 457 last 4 digits l PERA Military only if E None etc applicable l s re
7. The following is a checklist designed to help you prepare for the filing of your Inventory with Financial Plan and Conservator s Report To facilitate electronic reproduction of documents please type or legibly print your report in black ink LI Does your report have the case number the Protected Person s name and your address filled in at the top E If you or the Protected Person moved did you indicate the address change LI pia you sign the report If there are co conservators did they all sign the report Lbia you keep copies of bank statements and other financial records for possible future court review UL pbid you provide copies of the report to all interested persons as identified in the order of appointment and complete the certificate of service indicating that you did so CONSERVATOR S WORKSHEET IMPORTANT DATES TO REMEMBER Inventory with Financial Plan JDF 882 due on Conservator s Report JDF 885 due on The following Interested Persons identified in the Order of Appointment must be provided copies of the above reports The Certificate of Service on the reports must be completed prior to filing indicating that you have done so FINANCIAL INSTITUTION INFORMATION Name Contact Person Address City State Zip Code Phone Name Contact Person Address City State Zip Code Phone MEDICAL INFORMATION DR PA RN Name Phone
8. Address PHARMACY INFORMATION Pharmacy Name Phone Address RESIDENCE INFORMATION Name of Facility Contact Person Address Phone INSURANCE INFORMATION Policy Type Policy Number Agent Phone Address OTHER CONTACT INFORMATION Moves trict Court LA Denver Probate Court H ut County Colorado Court Address 00d Juska wu l i _ Hrometoon 80000 A COURTUSEONLY Case Number XX PR XXY Efo 3223 E SSAB nei ypurtonesk Bema ahi s Party oe Attorney Name and Address FAX Number Atty R Division Courtroom CONSERVATOR S INVENTORY WITH FINANCIAL PLAN i AETERNE PORN ETS DATE OF APPOINTMENT 10 1 2007 umyoprvyyy INVENTORY VALUES AS OF DATE MMIDDIVYYYY FILING DUE DATE MM DD IVYYYVY R Honet name of Conservator move this Court to approve this Winia Cie ended Conservator s Inventory with Financial Plan filed on date As grounds therefore the Conservator states the following 1 The information contained in the Inventory with Financial Plan is true and complete The proposed olan is necessary to protect and manage the income and assets of the protected person Z The Financial Plan is based on the actual needs and best interests of the protected person l understand that must provide copies of this Inventory with Financial Plan to the protected person and any others as ident
9. JDF 883 R4 09 ORDER REGARDING CONSERVATOR S FINANCIAL PLAN U District Court LI Denver Probate Court County Colorado Court Address In the Interests of A A Protected Person COURT USE ONLY Attorney or Party Without Attorney Name and Address Case Number Phone Number E mail FAX Number Atty Reg Division Courtroom CONSERVATOR S REPORT LIANNUAL REPORT LJAMENDED REPORT CURRENT REPORTING PERIOD FROM TO MM DD YYYY MM DD YYYY INTERIM REPORT DUE ON OFINAL REPORT If Final Report indicate why LI Protected Person deceased LI Minor turned 21 L Judicial Order The Conservator s Report pursuant to 15 14 420 C R S must be filed annually and served on all interested persons and the protected person pursuant to 15 14 404 4 C R S unless otherwise ordered Summarize the financial activity below after completing the detailed accounting information in Parts II and Ill Attach additional sheets if necessary Notice to Interested Person Interested persons have the responsibility to protect their own rights and interests within the time and in the manner provided by the Probate Code including the appropriateness of disbursements the compensation of fiduciaries attorneys and others and the distribution of estate assets Interested persons may file an objection with the Court The Court will not review or adjudicate these or other matters unless specifically requested to do so by an interested pers
10. Perah ms mme PLAN Page 3 of 7 Mo Motor Vehicles amp Recreation Vehicles Cnoluaina Year Make and Model _ Estimated Mo orcycles ATV s Boats etc Value i Value what you None could sellitfor i Inte current ene ene ee i ee condition l sarerea earner titre ep ereneencraenrn NEE amera a a n oe ee Soe mein E ET E OM me l Type of Estimated Property Value Home Rental Value what you Land etc could sell it for l i in ts current RT CMT ON eR ta aye D i condition c etic oS ee Ta perverse R j me 4 0 00 Ci None Estimated _ Value Value what you could sell it for in its current condition I Separately list and value items of significant value below for example Jewelry Antiques Collectibles Artwork ete l i 4 Miscellaneous aa Clothes Deeks t ty We eS ie pyres TET Z It ceca es E Estimated o Value Value what you _ could sell it for l inits current Te poet ae i ty tee ceed condition l SAE ENEAN E A a setae ok l Page 4 of 7 Part IV Inventory of Liabilities Debts Report the value of each llabillty debt in the chart below as of the Inventory date
11. digits only Uas of Last Day Day of of Prior Reporting Current Period or Reporting Linventory Period Checking Accounts Savings Accounts Other Cash Accounts e g Money Markets and CD s Stocks Bonds Mutual Funds Other Financial Investments Life Insurance Cash Value Pension and Retirement Funds Vested portion IRA s Annuities Motor Vehicles Real Estate report mortgage in liability debt section Home Furnishings Collections e g stamps or coins Other Assets Please list Total Assets Enter these amounts on page 1 Have Total Assets changed from the last day of the Prior Reporting Period or Inventory Lives LINo If Yes briefly explain the changes below Please include a description of any significant or unanticipated transactions 2 Liabilities Debts Description of Account Name of Financial Value on Last Last Day of Change in Liability Debt Number Institution dav of Current Amount of Identify all accounts last 4 J y Reporting Liability digits only Prior Period Reporting Period or Uinventory Mortgages principal due only Car Loans Home Improvement Loans Student Loans Credit Card Debt Federal Taxes Owed State and Local Taxes Owed Other Liabilities Debts Please list Total Liabilities Debts Enter these amounts on pa
12. A COURT USE ONLY A Case Number Protected Person Minor Division Courtroom ORDER ALLOWING WITHDRAWAL OF FUNDS FROM RESTRICTED ACCOUNT This matter comes before the Court on the Motion to Withdraw Funds from Restricted Account filed on date The Court having reviewed the Motion and supporting documentation if attached and any responses received from interested persons enters the following Orders L The Motion is GRANTED The Conservator is authorized to withdraw from the account s specified in the Motion and as identified below Name and Address of Financial Institution Account Amount to Number last Withdraw 4 digits only from Account Total LiThe Conservator is required to file a copy of the receipt s for the purchase with the Court within ten days Note All Conservators are required to keep all original receipt s LThe Motion is DENIED for the following reasons L The Court further Orders Date LiJudge Li Magistrate CERTIFICATION certify that this is a true and correct copy of the original in my custody Date Probate Registrar Deputy Clerk of Court JDF 869 R4 09 ORDER ALLOWING WITHDRAWAL OF FUNDS FROM RESTRICTED ACCOUNT RESTRICTED ACCOUNT LOG Name of Protected Person Date of Birth Name of Conservator Custodian Relationship to Protected Person Case Number Opening Balance Date Account Est
13. Description of Liability Debt Name of Financial Institution Account Balance Number last 4 digits only a 00 Mortgages p rincipal i due on ly Car Loans Home Impro vement Loans A O Other Liabi lities Debt Please fist Total Liabilities Debt Enter this amount in Part EEEREN PTER BH PENECAR REE PERTEN KEIN SR G cf 0 0 Part V Financial Plan List all expected sources of receipts income and disbursements expenses in the charts below If a specific category is not applicable indicate 0 in the projected monthly and annual amounts columns You will use these amounts when you file the initial Conservator s Report A Receipts Income l Indicate the amount of cash receipis income received on both a monthly and annual basis If an income amount such as wages is to be received on a monthly basis multiply the amount by 12 to determine the projected annual amount If an income amount such as dividends is to be received on an annual basis divide the amount by 12 to determine the projected monthly amount aes Monthly L Amount 600 2 __ 5 8 88 2560 2 Projected Annual Amount a 6 00 Bo Description of Receipt income Category Taare REcSipSACoRS Enter the total projected monthly and annual amounts
14. Occupation Your Relationship to Protected Person Address Apt City State Zip Code Telephone Numbers Home Work Cell E Mail Address If applicable Co Conservator s Information Name Do you plan on receiving any fees for being the Conservator Lives LINo If Yes indicate hourly rate Occupation Your Relationship to Protected Person Address Apt City State Zip Code Telephone Numbers Home Work Cell E Mail Address Part Summary of Inventory Summarize the Inventory below after completing the detailed accounting information in Parts Ill and IV A Total Assets Total from Part IlI B Total Liabilities Debt Total from Part IV Net Worth A minus B Part Il Summary of Financial Plan Receipts Income Minus Disbursements Expenses Summarize the Financial Plan below after completing the detailed accounting information in Part V Projected Monthly Projected Annual Amount Amount A A A Receipts Income Total from Part V A below B Disbursements Expenses Total from Part V B below Net Income A minus B Part Ill Inventory of Assets Report the fair market value of each category of asset in the chart below as of the Inventory date By indicating None you are stating affirmatively that the protected person does not have assets in that category Note If additional space is needed separate sheets ma
15. of Letters required depends on the circumstances The cost is 20 75 a piece What if the Protected Person owns real estate Record Letters at the clerk and recorder s office in the county where the property is located Consult with your attorney about recording letters in other circumstances What is the difference between a guardian and conservator Guardian Assists with personal affairs such as housing and health care Conservator Assists with the financial affairs What happens to joint accounts It depends on the nature or the reason for the account For example if the account was established as a matter of convenience so the co owner can write checks for the protected person most likely the account should be transferred to the conservatorship If it was established for estate planning purposes no changes may be necessary What about business situations Call a lawyer When I was appointed was handed a stack notebook full of paperwork Why The law requires that you file reports with the Court This User s Manual is designed to help guide and assist you with the process and provide you with instructions and forms for the reporting requirements Refer to the Court s order for the dates that all reports are due Where can I get more of these blank reporting forms All forms are available free of charge in the Self Help section on the Colorado Judicial Department s website www courts state co us You may also get blan
16. Case Number Phone Number E mail FAX Number Atty Reg Division Courtroom MOTION TO WITHDRAW FUNDS FROM RESTRICTED ACCOUNT I name of Conservator s respectfully request authority to withdraw on deposit in the restricted account s listed below Attach current bank statement Name and Address of Financial Institution Account Current Number last Balance in 4 digits only Account Total The funds are requested for the following purchase reasons s Attach supporting documentation for your request Signature of Conservator and or Attorney Date Signature of Conservator and or Attorney Date Address Address City State and ZipCode City State and Zip Code LCheck if new address LCheck if new address Date Signature of Minor if 12 years of age or over Certificate of Service certify that on date a copy of this Motion to Withdraw Funds from Restricted Account was served on each of the following Name of Person to Whom You Relationship to Address Manner of are Sending this Document Protected Service Interested Persons Person Insert one of the following Hand Delivery First Class Mail Certified Mail E Served or Faxed Signature JDF 868 R4 09 MOTION TO WITHDRAW FUNDS FROM RESTRICTED ACCOUNT LI District Court LDenver Probate Court County Colorado Court Address In the Interest of
17. ITH FINANCIAL PLAN Page 1 of 7 ee County Colorado Lomelourn user 80000 Ima Protected _Protected Person A COURTUSE ONLY A l Attorney or Party Without Attorney Name and Address Case Number y PR XXX l E mail Atty Reg l Division _ Courtroom O ee ees ee CONSERVATOR S REPORT Nae tt cel te ale et ane ath MANNUAL REPORT AMENDED REPORT CURRENT REPORTING PERIOD FROM 0 1 PO TTO 12 3 1 200 MM DD YYYY MM DD YYYY MINTERIM REPORT DUE ON 0 1 2008 CIFINAL REPORT if Final Report indicate why Protected Person deceased L Minor turned 21 Cluudicial Order The Conservator s Report pursuant to 15 14 420 C R S must be filed annually and served on all interested persons and the protected person pursuant to 15 14 404 4 C R S unless otherwise ordered Summarize the financial activity below after completing the detailed accounting information in Parts Il and IH Attach additional sheets if necessary Notice to Interested Person Interested persons have the responsibility to protect their own rights and interests within the time and in the manner provided by the Probate Code including the appropriateness of disbursements ihe compensation of fiduciaries attorneys and others and the distribution of estate assets Interested persons may file an objection with the Court The Court will not review or adjudicate these or other matters unless specifically request
18. Income Taxes FICA and Medicare Taxes Health Care including health insurance prescriptions Other Insurance Rent or Mortgage Property Taxes and Assessments Repairs and Maintenance Utilities including phones Home Furnishings Food and Household Supplies Clothing Personal Care Auto Expenses Education Entertainment Vacations and Travel Monthly Debt Repayments excluding mortgage Other Disbursements Expenses e g gifts Please list Other Disbursements Expenses Please list Total Disbursements Expenses Enter the total projected monthly and annual amounts in Part Il C Projected Payments to Professionals Do you expect to pay any fees to professionals including any fees you receive for being the Conservator Lives LINo If Yes list below projected payments to professionals that will serve you as conservator the protected person or the estate Include any fees you plan to receive as the Conservator Type of Professional and Name of Individual Projected Monthly Projected Amount Annual Amount Conservator Guardian Guardian ad litem Legal fees for Protected Person Legal fees for Conservator Legal fees for Guardian Legal fees for Petitioner Accountant CPA Case Manager Other Other Total Professional Fees Enter totals in Part V Section
19. LINo unanticipated transactions If Yes briefly explain the changes below Please include a description of any significant or 3 Net Income Total Receipts Income Minus Total Disbursements Expenses Net Income Prior Reporting Period or Financial Plan Current Reporting Period Receipts Income minus Disbursements Expenses Item 1 Total minus Item 2 Total Enter these amounts on page 1 Part IV Payments to Professionals 1 List below payments to professionals that you are employing to serve you as conservator the protected person or the estate and the amounts paid to such professionals during this reporting period Include any fees you received as the Conservator Type of Professional and Name of Individual Total Amount Paid in Current Reporting Period Conservator Guardian Guardian ad litem Legal fees for Protected Person Legal fees for Conservator Legal fees for Guardian Legal fees for Petitioner Accountant CPA Case Manager Other Describe Other Describe Other Describe Other Describe Total Professional Fees Paid Enter total in Part Ill Item 2 2 For each professional listed above provide the following for the current reporting period Name hourly rate charged may include range of hourly rates if applicable number of hours worked total hourly fees other costs charged and a brief descriptio
20. User s Manual for Conservators in Colorado This User s Manuals for Conservators in Colorado is a collaborative effort of the staff of the State Court Administrators Office the Protective Proceedings Task Force and members of the Colorado Bar Association This manual is intended to assist the newly appointed Conservator and to identify your responsibilities and to introduce you to important Conservatorship issues This is not a comprehensive manual to address every situation as we have designed this manual to highlight many of the common situations that one may need to address as a Conservator You are expected to familiarize yourself with the provisions of the Colorado Uniform Guardianship and Protective Proceedings Act 15 14 101 C R S through 15 14 433 C R S that relate to protective proceedings for minors and adults the Colorado Rules of Probate Procedure and applicable case law Changes in the law may have occurred since this manual was published If you have questions on how to proceed consult your attorney before acting By obtaining an attorney s advice before you act you may avoid more costly legal services later It is highly recommend that appropriate professionals be consulted such as attorneys financial advisors and accountants Even if you do not have an attorney you are bound by the same rules and procedures as if you did The cost for professional assistance may be assessed to the conservatorship estate as long as the e
21. ablished Account Number Last 4 digits only Date of Amount of Reason for Request Amount Balance Request Request Allowed Remaining LI District Court LI Denver Probate Court County Colorado Court Address In the Interest of A Protected Person A COURT USE ONLY Attorney or Party Without Attorney Name and Address Case Number Phone Number E mail FAX Number Atty Reg Division Courtroom CONSERVATOR S INVENTORY WITH FINANCIAL PLAN AND MOTION FOR APPROVAL DATE OF APPOINTMENT MM DD YYYY INVENTORY VALUES AS OF DATE MM DD YYYY FILING DUE DATE MM DD YYYY name of Conservator move this Court to approve this LY initial LJ Amended Conservator s Inventory with Financial Plan As grounds therefore the Conservator states the following 1 The information contained in the Inventory with Financial Plan is true and complete The proposed plan is necessary to protect and manage the income and assets of the protected person 2 The Financial Plan is based on the actual needs and best interest of the Protected Person understand that am required to maintain supporting documentation for all receipts and disbursements including detailed billing statements from any professional The Court or any Interested Person as identified in the Order Appointing Conservator may request copies a
22. ance on next year s report Date Check Description of item Received or Disbursed Amount Amount or include Name of Payee if Disbursement Received Disbursed I D No Page of state under penalty of perjury that this is a true and complete report of the administration of this estate during the period shown both dates inclusive to the best of my knowledge information and belief understand that this report is subject to audit and verification understand that am required to maintain supporting documentation for all receipts and disbursements including detailed billing statements from any professional The Court or any Interested Persons as identified in the Order Appointing Conservator may request copies at any time Date Signature of Conservator Date Signature of Co Conservator if applicable Certificate of Service certify that on date the original was e filed filed with the Court and a copy of this Conservator s Report was served on each of the following Name of Person You are Relationship to Address Manner Sending this Document Protected of To Interested Persons Person Service Insert hand delivery first class U S Mail certified U S Mail E filed or Fax Signature of Person Certifying Service Note The Conservator s Report must be filed annually and served on the protected person pursuant t
23. ce on next years report Description of item Received or Disbursed Amount Amount include Name of Payee if Disbursement Received Disbursed ji Part V Detail Listing of Receipts Income and Disbursements Expenses For each bank account included in Part Il Item 1 list below each individual item of Receipts income or Disbursements Expenses for the entire reporting period If applicable add additional pages and or a separate than one bank account Each Receipt Income should be listed in the Amount Received column and menvVExpense should be listed in the Amount Disbursed column Note This report should emble a check register for each bank account Name of Bank Account Number last 4 digits only Beginning Cash Balance This should match the ending balance from the last report Add Total Amount Received _ Enter total from listing below Less Total Amount Disbursed Enter total from listing below Ending Gash Balance This will be the beginning balance on next year s report T Check Description of item Received or Disbursed Amount Amount Loo Or include Name of Payee if Disbursement Received Disbursed LD No pO SAA A emenn ENE PERNE SOFEA VORRE PEIA EAE
24. d Information Regarding Your Appointment as a Conservator Duties as the Conservator of the Protected Person Manage and invest assets appropriately Make safe not risky investments Remember you are taking care of someone else s property Seek professional advice regarding investments as a fiduciary Maintain existing estate plan such as beneficiary designations and payable on death accounts Consider notifying credit reporting bureaus that this Conservatorship has been established and providing copies of the letters Locate collect and protect all assets You must keep the estate s money and property separate from anyone else s especially your own Do not deposit the Protected Person s money into your own account When you open a bank account for the estate the name on the account must be as follows as Conservator for Name of Conservator a Protected Person Name of protected person Each bank may have its own way to title the account but in any event the account title must reflect the Conservator Protected Person relationship Provide a certified copy of Letters of Conservatorship and Order of Appointment to each financial institution If real estate property exists you will need to record a certified copy of Letters of Conservatorship in the county where the property is located Consult with your attorney about recording letters in other circumstances Notify the pos
25. ddress In the Interests of A COURTUSEONLY A Case Number Protected Person Division Courtroom ACKNOWLEDGMENT OF RESPONSIBILITIES LICONSERVATOR AND OR LIGUARDIAN l full name acknowledge that was appointed as the Conservator and or Guardian for full name of protected person on date and understand that Letters will not be issued until this form is signed and provided to the Court With this appointment agree to comply with the statutory and court requirements and understand that am responsible for preparing and filing reports and or plans with the Court and serving all Interested Persons as identified in the Order of Appointment General Information and Responsibilities 1 am responsible for maintaining supporting documentation for all receipts into the accounts and all disbursements out of the accounts under my control during the duration of my appointment understand that the Court or any Interested Persons as identified in the Order of Appointment may request copies at any time 2 am responsible for providing the Court with any changes with my mailing or email address within 30 days 3 If funds must be placed in a restricted account understand that all withdrawals must be by court order U The Acknowledgment of Deposit of Funds to Restricted Account JDF 867 must be returned to the Court as documentation that the funds were deposited within 30 days or by date Q all requests fo
26. ed to do so by an interested person Summary of Net Worth Fair Market Value of Assets Minus Liabilities Debts Last Day of Last Day of Prior Reporting Period Current Reporting Period ormene i A Total Assets from Part Il item 1 ZE q S saa 023 8 Total Liabilities Debts from Part I item 2 ob OO A minus B Net Worth from Part Il Item 3 s225 29 18 Summary of Financia Activity Prior Reporting Period Current Reporting Period sa A Total Receipts Income from Part fll Item 1 G 175 22 FAD 8 Total Disbursements Expenses from Part Ill Item 2 10 155 2 1 085 2 A minus B Net Income from Part I Item 3 S oe OU ie a n oo Q i ri pi T gt a C ive a md oe T gt 2 T gt m m8 m psi Q p Ea i Page 1 of 9 Protected Person s Information Tma Polected Name Current Address Assist Livi 4 184 Take Care Ave nclugs Name of Living C mer or Nursing i A City State Zip Code Telephone Number T gq Age Conservator s Information Upu R Honest 2 Name Did you we any fees for being the Conservator during this reporting period kiyes MNo if Yes indicate hourly rate ance EA ET OT t upation Your Relationship to Protected Person child Addres 24 Main i Apt City Lometoun State usA Zip Code ZOOO Telephone Numbers Home ty Pan 3333 Work apm CLES Cell Cipbee 7777 ests e
27. ei Eebe B EE AA oD 2D l J i Education l f f a 5 a 200 w2 No ae atra ine nales in VAD Nes TOWN i Aer ok DO J ee oier Catt he an p bo holida dss Smu rars nr oe A ame Total Receipts i ncome Minus Total Disbursements Expenses lf Yes briefly explain the changes below Please include a description of any significant or Net Income Prior Reporting Current Reporting Period 2 35 2 JDE 885 CONSERVATOR S ANNUAL FINAL REPORT Page 6 of 8 Part IV Payments to Professionals 4 List below payments to professionals that you are employing to serve you as conservator the protected person or Pane estate and the amounts paid to such professionals during this reporting period Include any 3 ceived as the Conservator ee ES a e Total Amount Paid in Current Reporting Period Ses eae AOT E _ Other Describe Other Describe Other Describe Tota Professional Fees Paid O Enter total in Part H tem 2 i l fe 8 ment 2 For each professional listed above provide the following for the current reporting period Name hourly rate charged may include range of hourly rates if applicable number of hours worked total hourly foes other costs charged and a brief description of the services provided and benefit t
28. ge 1 Have Total Liabilities Debts changed from the last day of the Prior Reporting Period or Inventory Lives LINo unanticipated transactions 3 Net Worth Fair Market Value of Assets Minus Liabilities Debts If Yes briefly explain the changes below Please include a description of any significant or Last Day of Last Day of Prior Reporting Current Reporting Net Worth Period or Inventory Period Assets minus Liabilities Debts Item 1 Total minus Item 2 Total Enter these amounts on page 1 Part Ill Receipts Income and Disbursements Expenses Is this the Initial Conservator s Report filed Lives LINo If Yes use the amounts from the Inventory with Financial Plan JDF 882 to complete the column marked with an asterisk in items 1 and 2 below If No use the amounts from the prior Conservator s Report filed to complete the column marked with an asterisk in items 1 and 2 below Total Receipts Income Description of Receipt Income Category Total Amount of Total Amount of Change in Receipts Income from Receipts RUS LA UPrior Reporting Income for Receipt Pored r Current Income Reporting Period UL Financial Plan P g Wages Social Security Interest Dividends Pensions Retirement Plan Distributions Tax Refunds Proceeds from Sales of Assets Rental Income Gifts from Others Disability Unemployment or Worker s Compensation Other Public Assistance O
29. he amounts from the inventory with n JDF 882 to complete the column marked with an asterisk in items 1 and 2 below If Ne use s from the prior Conservator s Report filed to complete the column marked with an asterisk in Items Description of Asset Account Name of Financial Fair Market Fair Market Change identify all accounts Number institution Value Value in Value oo asto l iL i of dicks ory das of Last Day ee OU Asset l i of Prior Reporting Currant l ior Reporting i EE Minventory Period D Check ing Accounts Bank UD 1025 2 Le hal Savings Accounts Banik yy 642 Uf tpn ane Gage ae 6 9 Money Markets and l O DO O CD s csi 4 gt i 00 mie wo Stocks iol Rhu Ep 000 2 ep bes Pees os ER D D Mutual Fund z 4 oO D D DD D bo on 25000 76 p0 or and D0 0 Retirement Funds Cons g vested portion l ke ov d 00 ODD Sal 100 00 RAs 0 06 DD Annuities Motor Vehicles 5 Real Estate report ER j Ja man m mortgage in llability debt ector l l l Yo y a ihe changes below Please include a description of any signifi icant or unanticipated JDF 885 3 08 CONSERVATOR S ANNUAL FINAL REPORT Page 3 of 9
30. hip A link to an Actuarial Table is available on the resources page Maintain complete records of every financial transaction You may wish to establish a manual checkbook or a spreadsheet on EXCEL Quicken or similar financial software that reflects all income and expenditures with the estate Maintain all records for the duration of the Conservatorship The Court and Interested Persons can request documentation from the conservator at any time Subject to review by the court you may be entitled to reasonable compensation which may have tax consequences to you and or the Protected Person Complete and file with the Court required reports and plans File the initial Inventory with Financial Plan See the order of appointment for the due dates of filing File an amendment to the Inventory with Financial Plan whenever a substantial change a significant deviation from the original financial plan of circumstances occurs File Conservator s Reports as ordered Check the order of appointment for the due dates Provide copies of reports and plans to Interested Persons as identified in the order of appointment Frequently Asked Questions The following are frequently asked questions to assist you with your appointment as a Conservator Consult with your attorney if you have questions that are not addressed here What is the cost to obtain certified copies of Letters and Orders from the Clerk s Office The number
31. ified in the Order Appointing Conservator within 10 days of filing with the Court pursuant to 15 14 4044 C R S and will indicate having done so by completing the Certificate of Service at the end of this form understand that am required to maintain supporting documentation for all receipts and disbursements including detailed billing statements from any professional The Court or any Interested Persons as identified in the Order Appointing Conservator may request copies at any time understand that interested persons have the right to review and respond to information contained in the inventory with Financial Plan within 30 days of the date of service or by the date of any hearing whichever occurs Ele eek ISEL Notice to Interested Person Interested persons have the responsibility to protect their own rights and interests within the time and in the manner provided by the Probate Code including the appropriateness of disbursements the compensation of fiduciaries attorneys and others and the distribution of estate assets Interested persons may file an objection with the Court The Court will not review or adjudicate these or other matters unless specifically requested to do so by an interested person Protected Pora s Information Ira Name Shady Acres AestaecL Living 4 Tale Care Awe iter or Nursing Home State USA Zip Code QADDD Pa Z3 9449 Age EA JDF 882 3 08 CONSERVATOR S INVENTORY W
32. il Address Part Conservatorship Issues 1 Is there a continued need for the Conservatorship Lives LINo if No describe why and what steps should be taken If you would like the Court to take action you must file a motion with the Court Are the remaining assets in the estate sufficient to provide for the present and future care of the protected person Lives LINo if No describe why and what steps should be taken If you would like the Court to take action you must file a motion with the Court Attach a copy of the Bond to this Report unless the Bond was waived or not required by the Court What is the amount of the Bond ls the amount of the Bond sufficient to cover all unrestricted assets Ll Yes LINo If No describe why and what steps should be taken If you are requesting a change to the Bond you must file a motion with the Court Part Il Assets and Liabilities Debts Is this the first Conservator s Report filed LiYes LINo If Yes use the amounts from the Inventory with Financial Plan JDF 882 to complete the column marked with an asterisk in Items 1 and 2 below If No use the amounts from the prior Conservator s Report filed to complete the column marked with an asterisk in Items 1 and 2 below 1 Assets Description of Asset Account Name of Financial Fair Market Fair Market Change Identify all accounts Number Institution Value Value in Value last 4 as of Last of Asset
33. ipts income received on both a monthly and annual basis If an income amount such as wages is to be received on a monthly basis multiply the amount by 12 to determine the projected annual amount If an income amount such as dividends is to be received on an annual basis divide the amount by 12 to determine the projected monthly amount Description of Receipt Income Category Projected Monthly Projected Annual Amount Amount Wages Social Security Interest Dividends Pensions Retirement Plan Distributions Rental Income Gifts from Others Disability Unemployment or Worker s Compensation Other Public Assistance Other Receipts Income Please list Other Receipts Income Please list Total Receipts Income Enter the total projected monthly and annual amounts in Part Il If a specific B Disbursements Expenses Indicate the cash disbursement expense amount on both a monthly and annual basis If an expense such as utilities is to be paid on a monthly basis multiply the amount by 12 to determine the projected annual amount If an expense such as property taxes is to be paid on an annual basis divide the amount by 12 to determine the projected monthly amount Description of Disbursement Expense Category Projected Monthly Projected Annual Amount Amount Total Professional Fees Paid from Part C Distributions to Protected Person
34. istrict Court LIDenver Probate Court County Colorado Court Address In the Interest of A COURT USE ONLY A Case Number Protected Person Division Courtroom ORDER REGARDING CONSERVATOR S FINANCIAL PLAN This matter comes before the Court for approval of the Conservator s Financial Plan The Court having reviewed the Conservator s Inventory with Financial Plan and any responses or objections received from interested persons enters the following Order LiThe Financial Plan is APPROVED The Conservator is directed to file an amended Conservator s Inventory with Financial Plan whenever there is a change in the circumstances that requires a substantial deviation from this approved plan Approval does not relieve a Conservator from fiduciary standards L The Financial Plan is APPROVED with the following conditions L The Financial Plan is NOT APPROVED for the following reasons L The Conservator shall file an amended Conservator s Inventory with Financial Plan by date Li This matter shall be set for a hearing You are required to contact the Court by date to set this matter LitThe setting of bond was deferred when the Conservator was appointed Pursuant to 15 14 415 C R S bond is now set in the amount of The bond must be posted with the Court by date If bond is posted by a surety notice of any subsequent proceedings must be provided to the surety Date Judge UMagistrate
35. k forms at the clerk s office for a charge of 75 cents per page I need more copies of my proof of appointment Where can get them and what is the cost You may obtain copies at the clerk s office for a charge of 75 cents per page If you need any of the documents certified there is an additional charge of 20 00 per document need help completing all these reports Can the clerks help me Court clerks are not allowed to give legal advice or assist with the completion of forms If you need assistance it is highly advised that you seek the advice of a lawyer Am I personally liable for the protected person s expenses Not unless you agree to assume the liability by signing in your personal capacity rather than as conservator Always disclose your role as conservator The Protected Person lives with me May I charge rent You may charge a reasonable amount for rent and other living expenses These expenditures should be identified in the financial plan that you submit to the Court for approval There may be tax consequences to such payments How do I make the money last You are strongly encouraged to consult with your attorney and or a financial advisor There may be asset protection strategies available to you What do do if and when the money runs out There may be public benefits available You may want to consider selling or borrowing against assets Review the order of appointment to determine if court approval is required It ma
36. l 4058 35 _in Part Hl JBF 882 3 08 CONSERVATOR S INVENTORY WITH FINANCIAL PLAN Page 5 of 7 8 Disbursements Expenses indicate the cash cisbursemenl expense amount on both a monthly and annual basis if an expense such as utilities is to be paid on a monthly basis multiply the amount by 12 to determine the projected annual amount If an expense such as property taxes is to be paid on an annual basis divide the amount by 12 to determine the projected monthly amount a Description of Disbursemeni Expense ay Projected Monthly Projected Annual Amount 0 00 0D b 00 me Te O 6 OD 0DO A am edicare Taxes T D i DO 6 OO ene Care includ ing health insurance en AID OO 3720 se aie 60 0 00 00 Rent or Mortgage ANOO 2 AbD q Property Taxes and Assessmeftts 6 00 D OO Repairs and Maintenance S S utilities including phones 4 Home Furnishings Food and Household Supplies Clothing Personal Care 25 be T ano Expenses OD O sEducation eva Vacations and Travel Other Disbursemenis Expenses e g gifts Please list Other Disbursements Expenses Please list Total Disbursements Expenses pgo s ob Enter the total projected monthly and annual amounts ZID Toman UD 2D penina Cin Part i Se ere Nene rian Saas a C P
37. lorado org Alzheimer s Association Metro Denver www alzco org 303 813 1669 Alzheimer s Association www alz org 1 800 272 3900 Administration on Aging www aoa gov Americans with Disabilities Act www ada gov Autism Society of America Colorado Chapter http www autismcolorado org Benefits Check Up Colorado www benefitscheckup com 1 866 550 2752 Brain Injury Association of Colorado http www biacolorado org Cerebral Palsy of Colorado http www cpco org Colorado Bar Association www cobar orq 303 860 1115 Colorado Cross Disability Coalition http www ccdconline org RESOURCES R11 09 Page 1 of 3 Colorado Dept of Public Health and Environment www cdphe state co us 1 800 866 7689 within Colorado only Colorado Developmental Disabilities Council http www coddc org Colorado Division of Insurance www dora state co us insurance 303 894 7490 in the Denver Metro area 1 800 930 3745 from other parts of Colorado Colorado Fund for People with Disabilities http www cfpdtrust org Colorado Judicial Branch www courts state co us Community House Services Inc 303 831 4046 Consortium for Citizens with Disabilities http www c c d org County Department of Social Services www cdhs state co us servicebycounty htm Denver Regional Council of Governments www drcog orq 303 455 1000 Division of Aging and Adult Services http www cdhs state co us aas 1 888 866 4243 within Colorado only Elder Care Locator htt
38. mail OM E Mail Address lf applicable Co Conservator s Information D A Name Did you receive any fees for being the Conservator during this reporting period Yes CINo 1f Yes indicate hourly rate Occupation _ Your Relationship to Protected Person Address _ Apt A alan E State Zip Code Telephone Numbers Home Work Cell E Mail Address Part Conservatorship Issues t is there e continued need for the Conservatorship Wes INo If No describe why and what steps should be taken If you would like the Court to take action you must file a motion with the Court 2 Are the aye assets in the estate sufficient to provide for the present and future care of the protected person Mives CINo If No describe why and what steps should be taken If you would like the Court to take action you must file a motion with the Court 3 Attach a copy of the Bond to this Report unless the Bond was waived or not required by the Court What is the amount of the Bond ja Is the amount of the Bond sufficient to cover all unrestricted assets LYes LiNo If No describe why and what steps should be taken If you are requesiing a change to the Bond you must file a motion with the Court JDF 885 3 08 CONSERVATOR S ANNUAL FINAL REPORT Page 2 of 9 Part H Assets and Liabilities Debts arst Conservator s Report filed hres LiNo if Yes use t
39. n of the services provided and benefit to the estate The sum of the total hourly fees and other costs charged for each professional listed in the chart below should equal the total amount paid in the current reporting period in Item 1 above for that professional Name of Professional Hourly No of Total Other Brief Description of Services Rate Hours Hourly Costs Provided and Benefit to the Range Worked Fees Charged Estate Part V Detail Listing of Receipts Income and Disbursements Expenses For each bank account included in Part Il Item 1 list below each individual item of Receipts Income or Disbursements Expenses for the entire reporting period If applicable add additional pages and or a separate listing if more than one bank account Each Receipt Income should be listed in the Amount Received column and each Disbursement Expense should be listed in the Amount Disbursed column Note This report should resemble a check register for each bank account Name of Bank Account Number last 4 digits only Beginning Cash Balance This should match the ending balance from the last report Add Total Amount Received Enter total from listing below Less Total Amount Disbursed Enter total from listing below Ending Cash Balance This will be the beginning bal
40. o 15 14 404 4 C R S and interested persons pursuant to the Order Appointing Conservator unless otherwise ordered LI District Court LI Denver Probate Court County Colorado Court Address In the Interest of Ward Protected Person A COURTUSE ONLY A Attorney or Party Without Attorney Name and Address Case Number Phone Number E mail FAX Number Atty Reg Division Courtroom NOTICE OF CHANGE OF ADDRESS 1 name is the subject of a Li Conservatorship and or LI Guardianship 2 The L Protected Person LJWard has moved Court approval pursuant to 15 14 315 1 b C R S was granted for said move on date The new address is 3 The LIGuardian UConservator has moved The new address is 4 The Court in its Order Appointing Guardian or Conservator ordered that notice of all proceedings be given to the following person s Name Address Relationship Signature of Guardian Conservator or Attorney Date CERTIFICATE OF SERVICE certify that on date a copy of this Notice was served on each of the following Name of Person to Whom Relationship to Address Manner of you are Sending this Ward Service Document Insert one of the following Hand Delivery First Class Mail Certified Mail E Served or Faxed Signature JDF 752 R9 09 NOTICE OF CHANGE OF ADDRESS PREPARING TO FILE YOUR REPORT
41. o the estate The sum of the total hourly fees and other costs charged for each professional listed in the chart below should equal the total amount paid in the current reporting period in Item 1 above for that professional Name of Professional No of Total Other Brief Description of Services Hours Hourly Costs Provided and Benefit to the ee EE ens ange Worked Fees Charged Estate T tear l f j a f L E err _ ne aes e E i s ee eee l ee a eee a one INSERVATOR S ANNUAL FINAL REPORT Page 7 of 9 Part V Detail Listing of Receipts Income and Disbursements Expenses account taciuded in Part li Item 1 list below each individual item of Receipts income or or the entire reporting period If applicable add additional pages and or a separate one pai nk account Each Receipt Income should be listed in the Amount Received column and xpense should be listed in the Amount Disbursed column Note This report should sister for each bank ni 122 Account Number last 4 digits only prt This should match the ending balance from the last report Add Total Amount Received 4 220 we Enter total from listing below Beginning Cash Balance eo mount Disbursed 1L085 ao total from listing below s 832 283 This will bethe beginning balan
42. on Summary of Net Worth Fair Market Value of Assets Minus Liabilities Debts Last Day of Last Day of Prior Reporting Period Current Reporting Period or Inventory A Total Assets from Part Il Item 1 B Total Liabilities Debts from Part Il Item 2 A minus B Net Worth from Part Il Item 3 Summary of Financial Activity Prior Reporting Period Current or Financial Plan Reporting Period A Total Receipts Income from Part Ill Item 1 B Total Disbursements Expenses from Part Ill Item 2 A minus B Net Income from Part III Item 3 Protected Person s Information Name Current Address Include Name of Living Center or Nursing Home City State Zip Code Telephone Number Age Conservator s Information Name Did you receive any fees for being the Conservator during this reporting period Lives LINo If Yes indicate hourly rate Occupation Your Relationship to Protected Person Address Apt City State Zip Code Telephone Numbers Home Work Cell E Mail Address If applicable Co Conservator s Information Name Did you receive any fees for being the Conservator during this reporting period Lives LINo If Yes indicate hourly rate Occupation Your Relationship to Protected Person Address Apt City State Zip Code Telephone Numbers Home Work Cell E Ma
43. p www eldercare gov Eldercare Public Home asp Elder Law General Aging Smart Podcast http www elderlawanswers com PodCast PodCast asp Equal Employment Opportunity Commission www eeoc gov 1 800 669 4000 Guardianship Alliance of Colorado www guardianshipallianceofcolorado org 303 423 2898 Harrison Memorial Animal Hospital http cvmf org displaycommon cfm an 1 amp subarticlenbr 27 Healthy Aging for Older Adults www cdc gov aging 1 800 311 3435 RESOURCES R11 09 Page 2 of 3 Hero Alliance People with Disabilities Seeking Home Ownership National Guardianship Association Legal Center for People with Disabilities amp Older People Medicare Mile High Down Syndrome Association Senior Housing Options Social Security Administration Social Security Office Denver Region The Colorado Consumer Line Attorney General s Office United Way RESOURCES R11 09 http www heroalliance org www qguardianship org http www thelegalcenter org www medicare gov 1 800 Medicare http www mhdsa org www seniorhousingoptions org 303 595 4464 www socialsecurity gov 1 800 772 1213 http www socialsecurity gov denver www ago state co us 1 800 222 4444 http national unitedway org Page 3 of 3 LI District Court LI Denver Probate Court County Colorado Court Address In the Interest of Protected Person Minor A COURTUSE ONLY 4 Attorney or Party Without Attorney Name and Address
44. r withdrawal must be in writing by submitting a Motion to Withdraw Funds JDF 868 4 have received the following information to review regarding my responsibilities U User s manual for Guardians LJ User s manual for Conservators LI Viewed DVD Video Q Pamphlets Ul Attendance at mandatory training session on date U Other 5 I understand that the following reports and or plans are due on date U Initial Guardian s Report Care Plan Adult JDF 850 LJ Conservator s Inventory with Financial Plan JDF 882 6 understand that the following reports are due on date and every year after on such day and month unless am notified by the Court U Guardian s Report Minor JDF 834 U Guardian s Report Adult JDF 850 LJ Conservator s Report JDF 885 My signature below indicates that have read and understand my responsibilities as a newly appointed Guardian and or Conservator Date Guardian and or Conservator Conservator Fiduciary Financial Plan Guardian Incapacitated Person Interested Person Letters Minor Petitioner Protected Person Prudent Investor Rule Respondent Ward Definitions A person at least 21 years of age who has been appointed by a court to manage the estate financial affairs of a Protected Person or a minor child under the age of 18 A person or institution who manages money or property of another and who must exercise a s
45. rojected Payments to Professionals u expect to pay any fees to professionals including any fees you receive for being the Conservator ClYes e MNo If Yes list below projected payments to professionals that will serve you as conservator the protected person or the estate include any fees you plan to receive as the Conservator Type of Professional and Name of individual Projected Monthly Projected T Amount Annual Amount Conservator 0 00 0 0D i 4 H I JDF 882 3 08 CONSERVATOR S INVENTORY WITH FINANCIAL PLAN Page 6 of 7 6 00 0 00 lt aaa i me a rr ial Fees Enter totals in Part V Section lexpenses BESEN EEN tener 0 00 penalty of perjury that this is a true and complete Inventory with Financial Plan of this estate riod shown both dates inclusive to the best of my knowledge information and belief atthis reportis subject to audit and verification Co Conservator s Signature Date Subscribed and affirmed or sworn to before me in the County of ne State of this day of 20 My Commission Expires Notary Public Clerk ries is r eeen Certificate of Service cee the original was e filed filed with the Court and a copy of this Relationship to Address l Manner Protected gt f i Service
46. s Uno lf Yes nee hourly rate Occupati om Bonel Teacher Your Relationship to Protected Person Address 125 Main et Apt City Hometown State usA Zip Code BOO0D _ Telephone Numbers Home AM 227 2332 work GID YU 6555 cei if applicable Co Conservator s Information j la a Name Do you plen on receiving any fees for being the Conservator Clyes LINo If Yes indicate hourly rate 0 Occupation Your Relationship to Protected Person Address Apt City State Zip Code Telephone Numbers Home Work Cell E Mail Address Part Summary of Inventory Summarize the inventory below after completing the detailed accounting information in Parts Jil and IV A Total Assets Total from Part Ill 25 l g 20 0 00 BE Total Liabilities Debt Total from Part IV Part li Summary of Financial Plan Receipts Income Minus Disbursements Expenses Summarize the Financial Plan below after completing the detailed accounting information in Part V Projected Monthly Projected Annual Amount Amount B58 22 26 700 A Receipts Income Total from Part V A below oo op amp B Disbursements Expenses Total from Part V B below X 5 285 HDb a feel Oo bo 3 oe Q eA SY Ti 4 gt Nod Ad iva Z lt mi yn al Q py ed ri T mi D a Q Ba re y p p 4 Page 2 of 7 if additio Note initial Wiehe
47. t any time understand that must provide copies of this Inventory with Financial Plan to the Protected Person and any others as identified in the Order Appointing Conservator within 10 days of filing with the Court pursuant to 15 14 404 4 C R S and will indicate having done so by completing the Certificate of Service at the end of this form LiThis matter is routine and expected to be unopposed will set this matter on the Non Appearance docket by filing JDF 712 OR Oli will set this matter for hearing on the appearance docket Notice to Interested Persons Interested persons have the responsibility to protect their own rights and interests within the time and in the manner provided by the Probate Code including the appropriateness of disbursements the compensation of fiduciaries attorneys and others and the distribution of estate assets Interested persons may file an objection with the Court The Court may not review or adjudicate these or other matters unless specifically requested to do so by an interested person Protected Person s Information Name Current Address Include Name of Living Center or Nursing Home City State Zip Code Telephone Number Age JDF 882 R4 09 CONSERVATOR S INVENTORY WITH FINANCIAL PLAN AND MOTION FOR APPROVAL Page 1 of 8 Conservator s Information Name Do you plan on receiving any fees for being the Conservator Lives LINo If Yes indicate hourly rate
48. t office creditors utility companies etc if you want mail sent to your address Review will and other arrangements in order to preserve the estate plan Evaluate and consider application for public benefits Insurance Matters Verify coverage for health property auto and life insurance Provide certified copy of Letters if necessary Confirm that premium payments are current Obtain coverage if policies have lapsed Tax Matters Make sure income and property taxes are current including estimated quarterly tax payments Plan for federal and state tax payments Consider consulting a Certified Public Accountant CPA If you are a conservator for a minor remember that minors may be required to file tax returns Plan ahead if you will require court authority to make withdrawals necessary to meet the tax payment Allow 10 business days for the court to consider your request Develop a Financial Plan for court approval Identify income that will be received This may include Social Security benefits pension Income tax refunds etc Identify expenditures that must be paid This may include rent home maintenance cost of care medications bond and insurance premiums taxes etc Verify appropriateness of investments and accounts with a professional Take in to account the protected person s estate plan Planning finances in terms of the anticipated duration of the conservators
49. tandard of care in such management activity imposed by law Information to the Court that outlines how the Protected Person s assets and income will be invested or applied for his or her best interests A person at least 21 years of age who has qualified to have the care and management of an incapacitated person or a minor child under the age of 18 An adult person who lacks sufficient understanding or capacity to make or communicate responsible decisions concerning that person s physical health safety or self care even with appropriate and reasonably available technological assistance Persons identified by Colorado Law who must be given notice of a Conservatorship proceeding and or Guardianship proceeding This can be spouse adult children and other family members A formal document issued by the Probate Court appointing one as a Guardian and or Conservator An unemancipated individual who has not attained 18 years of age A person who files a Petition for of a Conservator Guardian the Appointment A person for whom a Conservator has been appointed A standard that a Conservator shall exercise when investing and managing the Conservator s assets The Conservator shall exercise reasonable care and skill when making investment and management decisions A person who is the subject of a Guardianship and or Conservatorship proceeding prior to findings of incapacity A person for whom a Guardian has been appointe
50. ther Receipts Income Please list Total Receipts Income Enter these amounts on page 1 Have Total Receipts Income changed from the Prior Reporting Period or Financial Plan Lives LINo If Yes briefly explain the changes below Please include a description of any significant or unanticipated transactions 2 Disbursements Expenses Description of Disbursement Expense Category Total Amount of Disbursement Expense from UPrior Reporting Period or L Financial Plan Total Amount of Disbursement Expense for Current Reporting Period Change in amount of Disbursement Expense Total Professional Fees Paid from Part IV Item 1 Payment to Professionals Distributions to Protected Person Income Taxes FICA and Medicare Taxes Health Care including health insurance and prescriptions Other Insurance Rent or Mortgage Property Taxes and Assessments Repairs and Maintenance Utilities including phones Home Furnishings Food and Household Supplies Clothing Personal Care Auto Expenses Education Entertainment Vacations and Travel Other Disbursements Expenses e g gifts Please list Total Disbursements Expenses Enter these amounts on page 1 Have Total Disbursements Expenses changed from the Prior Reporting Period or Financial Plan Lives
51. ue what you could sell it for in its current condition General Household and Other Personal Property Total value except for items listed below Separately list and value items of significant value below for example Jewelry Antiques Collectibles Artwork etc Total Miscellaneous Assets List each one separately and be specific Estimated Value what you could sell it for in its current condition Total Total Assets Enter this amount in Part I Part IV Inventory of Liabilities Debts Report the value of each liability debt in the chart below as of the Inventory date Description of Liability Debt Name of Financial Institution Account Number last 4 digits only Balance Mortgages principal due only Car Loans Home Improvement Loans Student Loans Credit Card Debt Federal Taxes Owed State and Local Taxes Owed Other Liabilities Debt Please list Other Liabilities Debt Please list Total Liabilities Debt Enter this amount in Part I Part V Financial Plan List all expected sources of receipts income and disbursements expenses in the charts below category is not applicable indicate 0 in the projected monthly and annual amounts columns You will use these amounts when you file the initial Conservator s Report A Receipts Income Indicate the amount of cash rece
52. xpense was incurred in the collection care administration and protection of the estate This work is produced as a public service and copies of these materials may be reprinted with acknowledgment without violation of applicable copyright laws The User s Manual for Conservators is also available on the Colorado Judicial Branch website at www courts state co us We would appreciate your feedback If you have any comments or suggestions or if you require additional information please feel free to contact cyndi hauber judicial state co us Conservator s Manual Table of Contents 1 Acknowledgment Form This is also a good place to place any Orders you receive from the Court 2 Definitions 3 Information Regarding Your Appointment as a Conservator 4 Frequently Asked Questions 5 Resources 6 Blank Forms to get You Started JDF 868 JDF 869 JDF 870 JDF 882 JDF 885 JDF 752 C E E A E G Motion to Withdraw Funds from Restricted Account Order Allowing Withdrawal of Funds from Restricted Account Restricted Account Log Conservator s Inventory with Financial Plan Conservator s Report Notice of Change of Address 7 Pre filing Report Checklist and Worksheet 8 Sample Forms Completed You may wish to maintain your personal information in this manual as this may be a great place for you to maintain financial documentation receipts etc L District Court LDenver Probate Court County Colorado Court A
53. y be appropriate to terminate the conservatorship My siblings and I are arguing about the way I m managing the money What can do Your siblings have the right to take any of their concerns to the court however you as the conservator have the power to manage the assets and carry out the approved financial plan What happens when the protected person dies Notify the court by filing a verified notice of death JDF 853 Within 60 days you must file a petition to terminate the conservatorship and schedule of distribution JDF 888 After death the conservator may only take the steps necessary to protect the assets of the estate and pay the funeral expenses What if the protected person gets well and doesn t need my help any longer You or the protected person may file a petition to terminate the conservatorship Generally a hearing will be required with the protected person present unless excused for good cause What would happen if didn t file the required reports plans or didn t comply with court orders The court can impose appropriate sanctions including removal fines contempt of court arrest and imprisonment Resources AARP in Colorado http www aarp org states co 1 888 687 2277 ARC of Colorado http www thearcofco org ARC of the United States http www thearc org NetCommunity Page aspx pid 183 Actuarial Table www ssa gov OACT STATS table4c6 htm Alliance Colorado Community Center Boards http allianceco
54. y be used If additional items are discovered after the initial inventory has been completed a supplemental inventory listing those additional item s shall be completed Cash on Hand Bank Checking Savings Certificate of Type of Account Account Balance Deposits or Health Accounts Name of Bank or last 4 Financial Institution digits LJ None only Total Stocks Bonds Mutual Funds Securities and Investment Accounts Number of Current Value LiNone Shares or Identify Account Number last 4 digits only Total Life Insurance Name of Company Beneficiary Type of Policy Face Amount Cash Value U None of Policy Total Pension Profit Sharing Annuities or Retirement Type of Plan Account Current Value Funds 401 k IRA 457 last 4 digits PERA Military only if L None etc applicable Total Motor Vehicles amp Recreation Vehicles Including Motorcycles ATV s Boats etc Year Make and Model Estimated Value Value what you 0 None could sell it for in its current condition Total Real Estate Indicate address Type of Estimated LL None Property Value Home Rental Value what you Land etc could sell it for 3 F in its current condition Total General Household and Other Personal Property Estimated U None Value Val
Download Pdf Manuals
Related Search