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Case No.

Dept. No. 1

IN THE FOURTH JUDICIAL DISTRICT COURT

OF THE STATE OF NEVADA, IN AND FOR THE COUNTY OF ELKO

In the Matter of the Guardianship of:

_________________________________,

_________________________________,

_________________________________,

A Minor

An Adult

GUARDIAN’SACKNOWLEDGMENT

OF DUTIES ANDRESPONSIBILITIES

UNDER NRS 159

TEMPORARY GUARDIANSHIP GENERAL GUARDIANSHIP

Person Person

Estate Estate

Person and Estate Person and Estate

SPECIAL GUARDIANSHIP NOTICES/SAFEGUARDS

Person Blocked Account Required

Estate Bond Required

Person and Estate

Summary Administration

I, (your name) ___________________________________, Guardian, hereby declare that

I understand there are certain duties and responsibilities required of me in the administration of

the above guardianship. By initialing each item below, I understand my guardianship duties and

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responsibilities include but are not limited to the following: (You must read and initial all items

on this form to acknowledge that you understand your duties and responsibilities):

I. Required duties and functions [ALL GUARDIANS]

_____ Filing an Order Appointing Guardian within ten (10) days of the undersigned’sappointment as guardian;

_____ Filing a Notice of Entry of Order Appointing Guardian within two (2) days of thefiling of the Order Appointing Guardian;

_____Filing of General Letters of Guardianship within fourteen (14) days of the filing ofthe Order Appointing Guardian;

_____ Seeking the advice and assistance of an attorney if the Guardian needs legaladvice or does not understand his/her duties and responsibilities to ensure he/sheremains in full compliance with the laws of the State of Nevada; [NRS 159.105]

_____ Filing a petition, setting a hearing and noticing all persons entitled to notice if thequalifications of the Guardian change after appointment as Guardian, i.e., ahearing must be held if:

_____ The Guardian plans to move or has moved out of state; [NRS 159.059(5)]

_____ The Guardian is judicially determined to have committed abuse, neglect orexploitation of a child, spouse, parent, or other person; [NRS 159.059(6)]

_____ The Guardian is convicted of a felony; [NRS 159.044(I); NRS 159.059(3)]

_____ The Guardian is suspended for misconduct or disbarred from the practiceof law, the practice of accounting, or any other profession which involvesthe management or sale of money, investments, securities or real property,and requires licensure in Nevada or any other state; [NRS 159.059(4)]

_____ The Guardian is in the process of filing for bankruptcy, or has filed forbankruptcy; [NRS 159.044(t)]

_____ Guardian must notify the Court, and certain other persons, within thirty (30) daysof the death of a Ward; [NRS 159.073(c)(1)(v)]

_____ Guardian is required to respond to the inquiries of a duly appointed GuardianshipCompliance Administrator; [NRS 159.046]

/ / /

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/ / /

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II. Duties of the Guardian of the Person [REQUIRED FOR GUARDIAN(S) OFTHE PERSON ONLY OR OF THE PERSON AND ESTATE]

_____ Guardian is required to file an annual Report of the Guardian every year tobring the Court up to date on the health and well-being of the Ward. TheReport must be filed within one (1) year and sixty (60) days of theanniversary of the Guardian’s appointment as guardian of the person of theWard; [NRS 159.081]

_____ Guardian shall supply the Ward with proper care, including food, shelter, clothing,and necessities; maintenance; support; and education, including training for aprofession if applicable; [NRS 159.079(1)(a)]

_____ Guardian shall supply the Ward with surgical, dental, psychiatric, psychological,hygienic, or other care and treatment as needed; [NRS 159.079(1)(b)]

_____ Guardian shall not consent to the experimental medical, biomedical, or behavioraltreatment of the Ward; the sterilization of the Ward; or the participation of theWard in any biomedical or behavioral experiment; [NRS 159.0805(1)]_____ Should the Guardian believe such treatment is of direct benefit to the

Ward, and intended to preserve the life of or prevent serious impairment tothe Ward the Guardian shall petition the Court to authorize suchtreatment as is required.

_____ Guardian shall obtain Court authority prior to authorizing the placement of aWard in a secured residential long-term care facility; [NRS 159.079(6)]

_____ Guardian shall petition the Court to obtain authority prior to removing the Wardfrom the State of Nevada; [NRS 159.079(5)]

_____ Guardian shall petition the Court to obtain authority prior to authorizing thechange of state of residence of or domicile of the Ward; [NRS 159.079(5)]

II. Duties of the Guardian of the Estate [REQUIRED FOR GUARDIAN(S) OF THEESTATE ONLY OR OF THE PERSON AND ESTATE]

_____ Guardian shall place assets into a blocked account, if required by the Court OrderGranting Guardianship, and obtain and file proof of the blocked account;[NRS 159.065(6)]

_____ Guardian shall obtain a bond, if required by the Court Order GrantingGuardianship, and obtain and file notice of bond; [NRS 159.065]

_____ Guardian is required to file an inventory and appraisement setting forth thedescription and valuation of the income and assets that comprise the Ward’sestate within sixty (60) days of the undersigned’s appointment as Guardianof the estate of the Ward; [NRS 159.085(1)]

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Requirements of the Inventory and Appraisal:

_____ The appraisal or valuation must be done by a disinterested appraiser,certified public accountant, or expert in valuation, unless the value of anasset can be determined with reasonable certainty; [NRS 159.086(1)]

_____ Guardian may be able to file a verified record of value; [NRS 159.086(2)(a)]

_____ Guardian may use a statement of the assessed value of real property asdetermined by the County assessor for purposes, except that if the realproperty is to be sold, the Guardian must file an appraisal;[NRS 159.086(2)(b)]

_____ Guardian must file an inventory unless the requirement of an inventorywas specifically waived in the Court Order Appointing the Guardian. Thisrequirement endures even if the Ward has no assets. The inventory mustbe a separate pleading filed after the grant of guardianship.

_____ Guardian is required to file an Accounting every year within one (1) yearand sixty (60) days of the anniversary of the undersigned’s appointment asGuardian of the estate of the Ward. Guardian shall contact the Court to setthe Accounting on the Court’s calendar for hearing and approval. [NRS 159.177(1)]

Requirements of the Accounting:The Accounting shall set forth:

_____ The amounts received on behalf of the Ward; [NRS 159.179(1)(b)]

_____ The amounts disbursed on behalf of the Ward; [NRS 159.179(1)(b)]

_____ The balance of the Ward’s estate which the Guardian continues to hold.

_____ Guardian shall keep precise and accurate records of all funds received anddisbursed for the Ward’s benefit, along with the source of all receipts and thepurpose of all disbursements. The undersigned understands that this includes, butis not limited to balancing estate checkbooks and insuring that all records areclear, legible, and balance with the figures referenced in all bank accounts;

_____ Guardian shall protect, preserve, and manage the Ward’s estate according to thelaws and in the best interest of the Ward;

_____ Guardian shall secure originals, when available, or copies of the followingdocuments:

_____ Any contract executed by the Ward;

_____ Any power of Attorney for the Ward;

_____ Any estate planning documents;

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_____ Any revocable or irrevocable trust in which the Ward has a vested interestas a beneficiary;

_____ Any writing depicting a present or future interest in any real or intangibleproperty.

IV. Investing and Managing Ward’s Estate [GUARDIAN OF ESTATE OR OFPERSON AND ESTATE]

_____ When establishing bank accounts or holding property on behalf of the Ward, titledesignations shall read: “Name of Guardian(s)” as Guardian(s) of the estate of“name of the Ward.” [NRS 159.043]

_____ Guardian may not utilize any guardianship funds for his/her personal benefit orcommingle guardianship funds with his/her own funds;

_____ Guardian shall not place the guardianship funds in joint tenancy;

_____ Guardian may, without prior approval of the Court, invest the Ward’s funds in anFDIC or FSLIC insured savings account in any bank, credit union, or savings andloan institution in the State of Nevada; interest bearing obligations of or fullyguaranteed by the United States, or the United States Postal Service; or interestbearing general obligations of any county, city, or school district in Nevada, theState of Nevada, or Federal National Mortgage Association; or any money marketmutual funds which are invested only in those instruments described in thisparagraph. [NRS 159.117(2)]

_____ Guardian is required to petition the Court prior to taking any of the following actions:

_____ Invest the property of the ward pursuant to NRS 159.117.

_____ Continue the business of the ward pursuant to NRS 159.119.

_____ Borrow money for the ward pursuant to NRS 159.121.

_____ Except as otherwise provided in NRS 159.079, enter into contracts for theWard or complete the performance of contracts of the ward pursuant toNRS 159.123.

_____ Make gifts from the ward’s estate or make expenditures for the ward’srelatives pursuant to NRS 159.125.

_____ Sell, lease or place in trust any property of the ward pursuant to NRS 159.127.

_____ Exchange or partition the ward’s property pursuant to NRS 159.175.

_____ Release the power of the ward as trustee, personal representative orcustodian for a minor or guardian.

_____ Exercise or release the power of the ward as a donee of a power ofappointment.

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_____ Exercise the right of the ward to take under or against a will.

_____ Transfer to a trust created by the ward any property unintentionallyomitted from the trust.

_____ Submit a revocable trust to the jurisdiction of the court if: (1) The ward orthe spouse of the ward, or both, are the grantors and sole beneficiaries ofthe income of the trust; or (2) The trust was created by the court.

_____ Pay any claim by the Department of Health and Human Services torecover benefits for Medicaid correctly paid to or on behalf of the ward.

_____ Transfer money in a minor ward’s blocked account to the Nevada HigherEducation Prepaid Tuition Trust Fund created pursuant to NRS 353B.140.

V. CERTIFICATION [ALL GUARDIANS]

I certify that I have read and reviewed the Guardian’s Acknowledgment of Duties and

Responsibilities under NRS 159, and that I understand the terms and conditions under which the

Guardianship is to be managed. I agree to comply with the rules and duties of a guardian as set

forth in any applicable law of the United States, and the law of the State of Nevada, and any

applicable ordinance, resolution, or law of any state that may have jurisdiction over myself, the

Ward, or this Guardianship. I understand that failure to comply with the guardianship statutes, or

with any Order made by the Court, may result in my removal as Guardian and that I may be

subject to such penalties as the Court may impose.

Dated this _______ day of ___________________, 20___.

_______________________________________________(Your Signature)

_______________________________________________(Your Printed Name)

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