On July 30, 2018 a
Acceptance of Appointment and Oath
was filed
for Guardianship/Conservatorship
in the District Court of Hennepin County.
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State of Minnesota District Court
Probate Division
County of Hennepin .
,
'
, Judicial District: Fourth .
Court File No._Z_1-_G~£:E_R_‘_lg “‘28"!
Case Type: 14,
In
Ram Guardianship . - ., Acce p tance ofA [3 '
t tB :
El Conservatorship of gm} ig} A it“;
67;;
p011]; gilldual,
boroi‘lxfill M F‘lj»; Corporation
BY INDIVIDUAL: -
I, Dar F‘Cn W U€+$[,l“t (name), the appointed [Kl Guardian,
[j Conservator, of the above named ward or protected person, verify that I have watched the
Guardianship/Conservatorship Educational video and understand the duties and responsibilities of the role
for which I am being appointed; I hereby 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 thejurisdiction 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.
I declare under penalty of
perjury that everything I have stated in this document is true and correct.
Minn. Stat.§358.ll6. .
med ’W 0/
Dated: Z
I”? g , 2
20_'2~ Signature
Name: Darren W Veifif/ln
Address: 37b90 ELDVJBW R943
City/State/Zip:
Telephone:
Em
7L9 ‘
Clo. ire
7—7l
".
WI
5 614
5970 l
E—mail address:
(lorrpnva-lgilgfl Gen-l'iitry +3 l. nc‘l'
Date of Birth mm/dd/yy: (05
OBII‘T/
BY CORPORATION:
(“Corporation”) is a corporation under
the Laws of the State of Minnesota. As a condition to receiving letters as [:l Guardian, [3 Conservator,
the Corporation (1) accepts the duties of such office, (2) agrees to be bound by Minnesota law relating to
guardians and conservators, (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, and (4) employees of the corporation directly responsible for carrying out the
duties and responsibilities of a guardian and/or conservator have watched the
Guardianship/Conservatorship Educational Video and understand the duties and responsibilities of the
role of guardian and/or conservator.
The Corporation has authorized this acceptance to be signed in the corporate name.
I declare under penalty of perjury that everything I have stated in this document is true and correct.
Minn. Stat. § 358.1 16.
Dated: ,20___ BY:
ITS:
Address:
City/State/Zip:
Telephone:
E-mail address:
GAC 1-U Hennepin ENG Rev 3/16 www.mncourts.gov/forms Page 1 of1
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State of Minnesota District Court Probate Division County of Hennepin . , ' , Judicial District: Fourth . Court File No._Z_1-_G~£:E_R_‘_lg “‘28"! Case Type: 14, In Ram Guardianship . - ., Acce p tance ofA [3 ' t tB : El Conservatorship of gm} ig} A it“; 67;; p011]; gilldual, boroi‘lxfill M F‘lj»; Corporation BY INDIVIDUAL: - I, Dar F‘Cn W U€+$[,l“t (name), the appointed [Kl Guardian, [j Conservator, of the above named ward or protected person, verify that I have watched the Guardianship/Conservatorship Educational video and understand the duties and responsibilities of the role for which I am being appointed; I hereby 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 thejurisdiction 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. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat.§358.ll6. . med ’W 0/ Dated: Z I”? g , 2 20_'2~ Signature Name: Darren W Veifif/ln Address: 37b90 ELDVJBW R943 City/State/Zip: Telephone: Em 7L9 ‘ Clo. ire 7—7l ". WI 5 614 5970 l E—mail address: (lorrpnva-lgilgfl Gen-l'iitry +3 l. nc‘l' Date of Birth mm/dd/yy: (05 OBII‘T/ BY CORPORATION: (“Corporation”) is a corporation under the Laws of the State of Minnesota. As a condition to receiving letters as [:l Guardian, [3 Conservator, the Corporation (1) accepts the duties of such office, (2) agrees to be bound by Minnesota law relating to guardians and conservators, (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, and (4) employees of the corporation directly responsible for carrying out the duties and responsibilities of a guardian and/or conservator have watched the Guardianship/Conservatorship Educational Video and understand the duties and responsibilities of the role of guardian and/or conservator. The Corporation has authorized this acceptance to be signed in the corporate name. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.1 16. Dated: ,20___ BY: ITS: Address: City/State/Zip: Telephone: E-mail address: GAC 1-U Hennepin ENG Rev 3/16 www.mncourts.gov/forms Page 1 of1