Nebraska Adult Guardianship / Conservatorship Petition Packet

NEBRASKA ADULT GUARDIANSHIP / CONSERVATORSHIP PETITION PACKET

County Court Filing Packet — Nebraska Probate Code

PART 1 — PRE-PETITION CHECKLIST

Petitioner / Counsel: [_________________________________________]
AIP (Alleged Incapacitated Person): [_________________________________________]
Date of intake: [__/__/____]

1.1 Standing — § 30-2619(a)

☐ Petitioner is the AIP or any person interested in AIP's welfare
☐ AIP is age 19 or older (Nebraska age of majority)
☐ Venue confirmed — county court of county where AIP resides or is present

1.2 Less Restrictive Alternatives Considered

☐ Supported decision-making
☐ Durable POA for finances (Neb. Rev. Stat. § 30-4001 et seq. — UPOAA)
☐ POA for health care / advance directive (Neb. Rev. Stat. § 30-3401 et seq.)
☐ Representative payee (SSA)
☐ VA fiduciary
☐ Joint account, ABLE account, special needs trust
☐ Adult Protective Services intervention (Neb. Rev. Stat. § 28-348)
☐ Care management / case management
☐ Trust (revocable or irrevocable)

Why less restrictive alternatives are insufficient:
[____________________________________________________________]

1.3 Documents to Collect

☐ Medical records / physician's evaluation
☐ Asset/debt inventory
☐ Income statement (SSA, pension, wages)
☐ Existing POA, advance directive, will, trust
☐ Names/addresses of spouse, adult children, parents
☐ Proposed guardian's: criminal history check (Neb. State Patrol), Sex Offender Registry check (with affidavit CC-16-2-30), Adult/Child Abuse and Neglect Registry check (DHHS), credit report
☐ Proof of guardian training under § 30-2601.01 (or scheduled training)
☐ Filing fee or in forma pauperis affidavit

1.4 Type of Proceeding

☐ Limited guardianship of the person
☐ Full / plenary guardianship
☐ Standby guardian designation — § 30-2619(e)
☐ Limited conservatorship
☐ Full conservatorship
☐ Combined guardianship and conservatorship
☐ Temporary guardianship — § 30-2626 (limited duration / emergency)

PART 2 — VERIFIED PETITION FOR APPOINTMENT OF GUARDIAN AND/OR CONSERVATOR

IN THE COUNTY COURT OF [______________] COUNTY, NEBRASKA

Case No.: [_______________________]

VERIFIED PETITION FOR APPOINTMENT OF [☐ GUARDIAN] [☐ CONSERVATOR] [☐ GUARDIAN AND CONSERVATOR]

COMES NOW Petitioner, [PETITIONER FULL NAME], pursuant to Neb. Rev. Stat. §§ 30-2619 and 30-2637, and respectfully petitions this Court as follows:

2.1 Petitioner

1. Name: [_________________________________________]
2. Address: [_________________________________________]
3. Telephone: [(___) ___-____] Email: [______________________]
4. Relationship/interest in AIP: [_________________________________________]
5. Attorney for Petitioner (if any): [_________________________________________]
   NE Bar No.: [____________]

2.2 Alleged Incapacitated Person

6. Full legal name: [_________________________________________]
7. Date of birth: [__/__/____] Age: [____]
8. Residence address: [_________________________________________]
9. Current physical location (if different — facility, etc.): [_________________________________________]
10. Social Security Number (last 4 only): XXX-XX-[____]

2.3 Interested Parties Entitled to Notice — §§ 30-2625, 30-2634

2.4 Specific Allegations of Incapacity — § 30-2619(a); § 30-2619.01

Petitioner alleges that AIP lacks sufficient understanding to make or communicate responsible decisions in the following specific areas:

Brief description of physical and mental condition:
[____________________________________________________________]

Specific reasons prompting request for guardianship:
[____________________________________________________________]

2.5 Proposed Guardian / Conservator

11. Name: [_________________________________________]
12. Address: [_________________________________________]
13. Date of birth: [__/__/____] Occupation: [_________________]
14. Relationship to AIP: [_________________________________________]
15. Number of other wards/protected persons served: [____]
16. Whether proposed guardian/conservator is a "professional guardian": ☐ Yes ☐ No
17. Training under § 30-2601.01: ☐ Completed on [__/__/____] ☐ Will complete prior to hearing

2.6 Background Check Status — § 30-2602.02

☐ Nebraska State Patrol Criminal History Reports — completed [__/__/____]
☐ Sex Offender Registry check + Affidavit (Form CC-16-2-30) — completed [__/__/____]
☐ DHHS Adult/Child Abuse and Neglect Registry check — completed [__/__/____]
☐ Credit report from established credit reporting agency — completed [__/__/____]
☐ All reports to be filed at least 10 days before hearing

2.7 Conservatorship Allegations (if applicable) — § 30-2637

18. Estimated value of AIP's estate:

19. Monthly income: $[___________]
20. Reason conservator is needed: [_________________________________________]

2.8 Scope of Guardianship Requested

☐ Limited — specific powers requested: [_________________________________________]
☐ Full / plenary — reason limited is insufficient: [_________________________________________]
☐ Standby guardian — § 30-2619(e); name: [_________________________________________]

2.9 Prayer for Relief

WHEREFORE, Petitioner prays the Court:

A. Set this matter for hearing pursuant to Neb. Rev. Stat. § 30-2619(b);
B. Appoint an attorney to represent AIP if AIP has not retained counsel — § 30-2619(b);
C. Appoint a visitor pursuant to §§ 30-2619.01 and 30-2624;
D. Order a physician's evaluation of AIP pursuant to § 30-2619(c);
E. Direct service of personal notice on AIP and notice on interested parties pursuant to §§ 30-2625 and 30-2634, at least 14 days before the hearing;
F. After hearing, find AIP incapacitated by clear and convincing evidence and appoint [Petitioner / proposed guardian/conservator] as such with the [limited / full] powers requested;
G. Require bond as appropriate under Neb. Rev. Stat. § 30-2640;
H. Grant such other relief as is just and proper.

Respectfully submitted this [____] day of [______________], 20[____].

___________________________________
[PETITIONER SIGNATURE]
[PRINTED NAME]

___________________________________
[ATTORNEY FOR PETITIONER] (if any)
NE Bar No. [____________]

VERIFICATION

STATE OF NEBRASKA )
COUNTY OF [______________] ) ss.

I, [PETITIONER NAME], being first duly sworn, state under penalty of perjury that I have read the foregoing Verified Petition and that the facts stated are true and correct to the best of my knowledge, information, and belief.

___________________________________
[PETITIONER SIGNATURE]

Subscribed and sworn before me this [____] day of [______________], 20[____].

___________________________________
Notary Public
My commission expires: [__/__/____]

PART 3 — PERSONAL NOTICE TO ALLEGED INCAPACITATED PERSON (§ 30-2625)

TO: [AIP NAME], Alleged Incapacitated Person

You are notified that a Verified Petition has been filed in the County Court of [____________] County, Nebraska, asking the Court to find you incapacitated and to appoint a guardian and/or conservator for you. This proceeding may significantly limit your legal rights.

YOUR RIGHTS — § 30-2619(b), (d):

1. You may retain an attorney of your own choice. If you do not, the Court may appoint one to represent you.
2. The Court may also appoint a guardian ad litem under §§ 30-4201 to 30-4210 to advocate for your best interests.
3. You have the right to be present at the hearing virtually or in person and to see and hear all evidence.
4. You have the right to present evidence, compel witnesses, and cross-examine the court-appointed physician and visitor.
5. You may request a closed hearing.
6. You have the right to appeal any final order.

HEARING:

• Date: [__/__/____]
• Time: [____]:[____] [☐ a.m. ☐ p.m.]
• Judge: [______________________]
• Location: [_________________________________________]

This notice and a copy of the Verified Petition must be served on you personally at least fourteen (14) days before the hearing.

Dated: [__/__/____]

___________________________________
[PETITIONER / COUNSEL SIGNATURE]

PART 4 — NOTICE TO INTERESTED PARTIES (§§ 30-2625, 30-2634)

TO: [NAME OF INTERESTED PARTY]

You are notified that a Verified Petition has been filed in the County Court of [____________] County, Nebraska (Case No. [_______________________]) seeking the appointment of a guardian and/or conservator for [AIP NAME].

Hearing: [__/__/____] at [____]:[____] [☐ a.m. ☐ p.m.], Judge [______________________].

You may appear and be heard. To object, file a written response with the Clerk of the County Court and serve a copy on Petitioner's counsel.

Notice must be served at least fourteen (14) days before the hearing.

Dated: [__/__/____]

___________________________________
[PETITIONER / COUNSEL SIGNATURE]

PART 5 — CAPACITY / MEDICAL EVALUATION (§ 30-2619(c))

REPORT OF COURT-APPOINTED PHYSICIAN

Re: [AIP NAME] Case No.: [_______________________]

I, Dr. [______________________], M.D./D.O., having been appointed by this Court pursuant to Neb. Rev. Stat. § 30-2619(c) to examine the above-named individual, submit the following:

5.1 Examination

• Date: [__/__/____] Location: [_________________________________________]
• License: [_________________] No.: [____________] Specialty: [____________]
• Time spent: [____] hours

5.2 Diagnoses and Etiology

• Primary diagnosis (ICD-10): [_________________________________________]
• Secondary diagnoses: [_________________________________________]
• Etiology of cognitive impairment: [_________________________________________]

5.3 Functional Assessment

5.4 Prognosis and Recommendations

• Prognosis: ☐ Improving ☐ Stable ☐ Declining
• Expected duration: [____________]
• Hearing attendance: ☐ Can attend ☐ Should not attend — explain: [____________]
• Less restrictive supports recommended: [_________________________________________]
• Recommended scope of guardianship: ☐ None ☐ Limited ☐ Full

___________________________________
Dr. [______________________]

Date: [__/__/____]

PART 6 — APPOINTMENT OF VISITOR AND/OR GUARDIAN AD LITEM (§§ 30-2619.01, 30-2619.03, 30-4201 to 30-4210)

6.1 Order Appointing Visitor

The Court appoints [VISITOR NAME] as visitor pursuant to Neb. Rev. Stat. § 30-2619.01. The visitor shall:

a. Interview AIP in person;
b. Interview the proposed guardian/conservator;
c. Visit AIP's residence and proposed residence;
d. May interview the court-appointed physician — § 30-2619(c);
e. File a written evaluation with the Court within sixty (60) days of the filing of the petition, including recommendations regarding the proposed guardianship — § 30-2619.03.

The visitor's report shall be made available to the guardian ad litem, the proposed ward, and the petitioner. Parties shall have ten (10) judicial days to file a response — § 30-2619.04.

6.2 Order Appointing Guardian ad Litem (optional / discretionary)

The Court appoints [GAL NAME], NE Bar No. [____________], as guardian ad litem pursuant to §§ 30-4201 to 30-4210 to advocate for the best interests of AIP.

Date: [__/__/____]

___________________________________
County Court Judge

PART 7 — LESS RESTRICTIVE ALTERNATIVE ANALYSIS

Petitioner's statement: No less restrictive alternative is sufficient because: [_________________________________________]

___________________________________
[PETITIONER SIGNATURE]

PART 8 — BOND (§ 30-2640)

ORDER REQUIRING / WAIVING BOND

Pursuant to Neb. Rev. Stat. § 30-2640, the Court ORDERS:

☐ Conservator shall file bond in the penal sum of $[___________], with [☐ corporate surety ☐ personal surety] approved by the Court.
☐ Bond is waived because:
☐ All interested persons have consented in writing
☐ Estate is held in restricted accounts requiring court order to withdraw
☐ Other good cause: [_________________________________________]

Bond shall be filed before Letters of Conservatorship issue.

Date: [__/__/____]

___________________________________
County Court Judge

PART 9 — NOTICE OF HEARING

IN THE COUNTY COURT OF [______________] COUNTY, NEBRASKA

Case No.: [_______________________]
In the Matter of [AIP NAME]

NOTICE IS HEREBY GIVEN that a hearing on the Verified Petition for Appointment of Guardian and/or Conservator will be held:

• Date: [__/__/____]
• Time: [____]:[____] [☐ a.m. ☐ p.m.]
• Judge: [______________________]
• Location: [_________________________________________]
• Method: ☐ In person ☐ Virtual (Zoom/WebEx)

Personal notice on AIP and notice on interested parties pursuant to §§ 30-2625 and 30-2634 must be served at least fourteen (14) days before the hearing.

Background check reports and proof of training (§§ 30-2601.01, 30-2602.02) must be filed at least ten (10) days before the hearing.

Dated: [__/__/____]

___________________________________
Clerk of the County Court

PART 10 — FINAL ORDER OF APPOINTMENT AND LETTERS (§§ 30-2620, 30-2628)

ORDER APPOINTING [☐ LIMITED ☐ FULL] GUARDIAN AND/OR CONSERVATOR

This matter came before the Court on [__/__/____]. The Court considered the Verified Petition, the physician's report under § 30-2619(c), the visitor's evaluation under § 30-2619.03, the guardian ad litem's report (if appointed), background checks and training under §§ 30-2601.01 and 30-2602.02, and the testimony presented.

The Court FINDS by clear and convincing evidence that:

1. AIP is an incapacitated person within the meaning of Neb. Rev. Stat. § 30-2601;
2. Less restrictive alternatives are insufficient to meet AIP's needs;
3. The proposed guardian/conservator is qualified, has met training and background check requirements, and is suitable;
4. The least restrictive scope of guardianship/conservatorship necessary is [☐ limited ☐ full].

IT IS ORDERED:

A. [NAME] is appointed [☐ Limited ☐ Full] Guardian of the Person of [AIP NAME].
B. [NAME] is appointed [☐ Limited ☐ Full] Conservator of the Estate of [AIP NAME].
C. ☐ Standby guardian: [NAME] is designated pursuant to § 30-2619(e).
D. Guardian's powers (per § 30-2628): [_________________________________________]
E. Conservator's powers: [_________________________________________]
F. Bond: ☐ $[___________] ☐ waived.
G. Letters of Guardianship and Letters of Conservatorship shall issue upon acceptance of appointment and posting of bond.
H. Guardian shall file an annual report (§ 30-2630); conservator shall file an inventory within 90 days and an annual accounting (§ 30-2646).

Date: [__/__/____]

___________________________________
County Court Judge

LETTERS OF GUARDIANSHIP

The Clerk of the County Court of [____________] County, Nebraska, hereby certifies that [GUARDIAN NAME] has been duly appointed and qualified as Guardian of [AIP NAME], an incapacitated person, with the powers set forth in the Order of Appointment, and is authorized to act as such.

Dated: [__/__/____] Seal: [____]

___________________________________
Clerk of the County Court

LETTERS OF CONSERVATORSHIP

The Clerk of the County Court of [____________] County, Nebraska, hereby certifies that [CONSERVATOR NAME] has been duly appointed and qualified as Conservator of the Estate of [AIP NAME], having posted bond in the amount of $[___________] (or bond waived), and is authorized to act as such.

Dated: [__/__/____] Seal: [____]

___________________________________
Clerk of the County Court

PART 11 — INITIAL INVENTORY & ANNUAL ACCOUNTING REFERENCE (§§ 30-2630, 30-2646)

11.1 Initial Inventory (Conservator) — within 90 days of appointment

11.2 Annual Reports

• Guardian's annual report (§ 30-2630): AIP's residence, physical/mental condition, services received, changes in capacity, recommendation regarding continued guardianship.
• Conservator's annual accounting (§ 30-2646): receipts, disbursements, balances, supporting documentation.
• Filed within 30 days of anniversary of appointment.
• Served on AIP, AIP's attorney/GAL, and interested persons who requested notice.

11.3 Recordkeeping

☐ Separate fiduciary account titled "[NAME], Conservator for [AIP NAME]"
☐ No commingling
☐ Retain receipts/statements 7 years
☐ Court approval required for sale of real estate, distributions outside ordinary maintenance, self-dealing

SOURCES AND REFERENCES

• Neb. Rev. Stat. Chapter 30, Article 26 (Nebraska Probate Code — Protection of Persons Under Disability)
• Nebraska Supreme Court Guardianship/Conservatorship: https://supremecourt.nebraska.gov/programs-services/guardianship-conservatorship
• Nebraska Judicial Branch Guardianship/Conservatorship FAQ: https://nebraskajudicial.gov
• Background check forms (CC-16 series): https://supremecourt.nebraska.gov/forms
• Affidavit of Sex Offender Registry Search — Form CC-16-2-30
• LB 985 (2026) — Amendments to §§ 30-2619, 30-2623, 30-2628, 30-2636, 30-2655

END OF NEBRASKA ADULT GUARDIANSHIP / CONSERVATORSHIP PETITION PACKET