Free STATE OF MINNESOTA - Minnesota

M.S. 524.5-111

State of Minnesota

Select County County of _____________

District Court Probate Division Judicial District: ____________ Court File No. ______________ Case Type: 14, Conservatorship

Guardianship and In Re: Conservatorship of ______________________________, Ward and Protected Person

Acceptance of Appointment By: Individual Corporation

BY INDIVIDUAL: I, _______________________________(name), the appointed Guardian, Conservator, of the above named ward or protected person, accept my appointment and do solemnly swear that I will fully and faithfully perform all the duties of such office according to law and that I submit to the jurisdiction of the Court in any proceeding relating to this ward or protected person that may be instituted by the court or any person interested in the affairs of the ward or protected person. So help me God.
Dated: ___________________, 20___ Sworn/affirmed before me this _______________________________. ________________________________________ Signature Name: ___________________________ Address: ___________________________

______________________________
Notary Public \ Deputy Court Administrator

_________________________ City/State/Zip: _________________________
Telephone: ___________________________

My commission expires:_____________

___________________________________________________________________________ BY CORPORATION: ____________________________________________________________("Corporation") is a corporation under the Laws of the State of Minnesota. As a condition to receiving letters as Guardian, Conservator, the Corporation (1) accepts the duties of such office, (2) agrees to be bound by Minnesota law relating to guardians and conservators, and (3) submits to the jurisdiction of the Court in any proceeding relating to this ward or protected person that may be instituted by the court or any person interested in the affairs of the ward or protected person. The Corporation has authorized this acceptance to be signed in the corporate name. _______________________________________ BY: _________________________________ ITS: _________________________________
Address: ___________________________________ ___________________________________

Date: ___________, 20___
Sworn/affirmed before me this ______________________________.

______________________________
Notary Public \ Deputy Court Administrator

________________________________ City/State/Zip: ___________________________
Telephone: _____________________________

My commission expires:_____________

GAC 1-UM State

ENG

Rev 4/04

www.courts.state.mn.us/forms

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