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Probate

This chart provides only a brief overview of the Probate process. It does not provide a comprehensive outline of all of the steps and procedures that may be applicable in your specific case. For a detailed explanation about any of the topics listed you may talk to an attorney or visit the Nebraska Supreme Court Legal Resources and Information page. Trial Court Services Rev. 2/2020 AD 2:26 Demand for Notice (may be filed by creditor or interested party) Optional Key: Informal Probate with Will (Testate) Application for Informal Probate and Appointment of Personal Representative Affidavit of Mailing Notice Filed by ‘Interested Person’ at least 120 hours after death. Also filed: Original Last Will & Testament Notice of Informal Probate & Notice to Creditors for publication Registrar’s Statement Letters of Personal Representative Acceptance of Appointment within 10 days of appointment Bond (if ordered) Inventory (within 3 months of appointment) Informal closing of Estate by Verified Statement Informal Closing Receipts for signature of Judge or Registrar Claim (may be filed by Creditors) Inheritance Tax Worksheet Inheritance Tax w/ Notice of Hearing Order determining Inheritance Tax Certificate showing tax paid Formal Petition for Complete Settlement Notice of Hearing Formal Closing Receipts Decree of Discharge

Flowchart, Informal Probate with Will (Testate)

STATE OF NEBRASKA CC 15:1 REV 02/18 Neb. Rev. Stat. § 30-2413 DEMAND FOR NOTICE IN THE MATTER OF THE ESTATE OF , Deceased. CASE No. DEMAND FOR NOTICE 1. Pursuant to Nebraska Probate Code § 30-2413, the undersigned demands mailed notice pursuant to Nebraska Probate Code § 30-2220(a)(1) of any of the following Orders or filings pertaining to the estate of the deceased: Application for Informal Probate of Will Application for Informal Appointment of Personal Representative Inventory and any Supplemental Inventory Copy of published Notice to Creditors mailed within five days of publication Other (specify) 2. Demandant has the following financial or property interest in the estate of the deceased. 3.Demandant waives any publication of any notice pursuant to Nebraska Probate Code § 30- 2220(a)(2) with respect to each of the items for which notice is above demanded. 4.Notice should be mailed to the following-named Demandant or Demandant’s attorney at the address below: ** This Demand for Notice will be disposed of five years from the date it is filed if no estate is filed and no other action is taken, unless the court orders extended retention for good cause shown. Date: Signature Demandant Name Demandant Street Address/P.O. Box Bar Number and Firm Name (attorneys only) Demandant Phone/Fax Page 1 of 2 Demand for Notice CC 15:1 Rev. 02/2018 Demandant City/State/ZIP Code Demandant Email Address Page 2 of 2 Demand for Notice CC 15:1 Rev. 02/2018 CERTIFICATE OF MAILING I certify that I have mailed a copy of this Demand for Notice, in accordance with the requirements of Nebraska Probate Code § 30-2413, to , the Personal Representative of the deceased, first class mail, postage prepaid, at the following address, S treet Address/P.O. Box , on . City/State/ZIP Code Date: . Clerk Magistrate

Demand for Notice

STATE OF NEBRASKA STATEMENT OF CLAIM IN THE MATTER OF THE ESTATE OF Case No. STATEMENT OF CLAIM Claim No. , Deceased. TO THE CLERK OF THE COURT: Claim of the undersigned is hereby made against this estate, itemized as follows: Description of Claim Due Date, If Not Yet Due Amount See attached bill or other documentation. Total Claim: This claim is: Contingent Unliquidated and the nature of the uncertainty is: Secured, and a description of the security is: Unsecured. PRESENT THIS CLAIM TO THE COURT Date: Signature Claimant or Authorized Party Name Bar Number and Firm Name (attorneys only) Claimant or Authorized Party S treet Address/P.O. Box Claimant or Authorized Party City/State/ZIP Code Claimant or Authorized Party Phone/Fax Claimant or Authorized Party Email Address CC 15:2 REV 04/2018 Neb. Rev. Stat. § 30-2486 Page 1 of 1 Statement of Claim CC 15:2 Rev 04/2018

Statement of Claim

Nebraska State Court Form RELEASE OF CLAIM CC 15:3 Rev. 05/15 Page 1 of 1 Release of Claim CC 15:3 Rev. 05/15 County Forms Committee IN THE MATTER OF THE ESTATE OF , Deceased. Case No. _______________________ RELEASE OF CLAIM The undersigned claimant acknowledges delivery and receipt on of the following described payment which is the full amount of the claim to which the undersigned c laimant is entitled, to wit: Description of Claim: Amount: The undersigned claimant releases and forever discharges the personal representative of the estate from all claims and rights whatsoever which the undersigned may have in this estate with respect to such claim. Date: Signature Claimant Name Bar Number and Firm Name (attorneys only) Street Address/P.O. Box City/State/ZIP Code Phone Email Address Witness:

Release of Claim

TO THE PERSONAL REPRESENTATIVE OR TRUSTEE: This form is to be filed only with the Court. Do not send this form to the interested parties. Fill out one form for each deceased or settlor. THIS DOCUMENT IS CONFIDENTIAL AND SHALL NOT BE MADE PART OF THE COURT FILE OR PROVIDED TO THE P UBLIC PURSUANT TO NEB. CT. R. § 6-14 64. IN THE MATTER OF Case No.______________ ________________________. PERSONAL AND FINANCIAL INFORMATION OF PARTIES FOR ESTATES AND TRUSTS Full Name of the Deceased or Settlor: Full Date of Birth of the Deceased or Settlor: Full Social Security Number of the Deceased or Settlor: FINANCIAL INFORMATION OF THE DECEASED OR SETTLOR NAME AND ADDRESS OF FINANCIAL INSTITUTIONS FULL ACCOUNT NUMBER(S) 1.______________________________________________________________________ 2.______________________________________________________________________ 3.______________________________________________________________________ 4.______________________________________________________________________ Date Signature (s) Name(s) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box Number City/State/ZIP Code Phone Email Address Instructions: Whe n parties are required to report personal and financial information to the court, the complete information shall be provided on Appendix 8. On pleadings or documents to be filed with the court, financial account numbers, dates of birth, and Social Security numbers, where required, should reference Appendix 8: (i.e., “See Appendix 8”). Financial account numbers should be listed by the last four digits of the financial account when the account is reported on a pleading or document filed with the Court. This form is neither approved nor disapproved by any court or judicial tribunal. Use of this form provides no immunity from error. Appendix 8 adopted July 13, 2 0 10; a mended August 28, 2 013; amended January 22, 2015. PERSONAL AND FINANCIAL INFORMATION OF PARTIES FOR ESTATES AND TRUSTS Nebraska State Court Form Based on Appendix 8 (Neb. Ct. R.Chapter 6, Article 14) CC 15:4 New 08/16 Neb. Ct. R. §6-1464 Page 1 of 1 Personal and Financial Information of Parties for Estates and Trusts CC 15:4 New. 08/16

Personal and Financial Information of Parties for Estates and Trusts (Based on Ch 6 Art 14, App 8)

STATE OF NEBRASKA ) ) ss COUNTY OF ________________ ) (county in which the document will be signed) Affidavit for Transfer of Personal Property without Probate I, ________________________, under penalty of perjury under Nebraska Revised Statute § 28-915, (your name) swear or affirm the following to be true and material: 1.thirty days have passed since _______________________’s death; (deceased’s name) 2.a certified or authenticated copy of the deceased’s death certificate is attached to this affidavit; 3.the value of the entire estate of the deceased, _______________________, less liens and (deceased’s name) encumbrances (claims against or on the property), is $50,000.00 or less; 4.there is no Personal Representative, application for Personal Representative, or petition for Personal Representative; and 5.I am entitled to payment and delivery of all property held by others in the sole name of the deceased, ________________________, pursuant to Nebraska Probate Code § 30-24,125 and because of my (deceased’s name) relationship as ____________________________________ to the deceased. As provided under Nebraska Probate Code § 30-24,126, the person releasing personal property or the evidence of property based upon this affidavit is discharged and released just as if that person dealt with a Personal Representative of the deceased. The person releasing the property is not required to see to the application of the personal property or evidence of that application or to inquire into the truth of any statement in this affidavit. A transfer agent of any security shall change the registered ownership on the books of a corporation from the decedent to the successor or successors upon the presentation of the affidavit. __________________________________________ Sign a ture (do NOT sign UNTIL A NOTARY IS PRESENT AND WITNESSES YOU SIGNING) _______________________________________ Date _______________________________________ Address (line 1) _______________________________________ Address (line 2) Page 1 of 1 Affidavit for Transfer of Personal Property without Probate CC 15:40 Rev. 06/19 Pro Se Committee , This document was acknowledged before me by this day of , 20 . Notary commission expires: Signature of Judge/Clerk of the Court/Notary Public Title: Serial Number (if any):

Affidavit for Transfer of Personal Property without Probate

Page 1 of 2 Affidavit for Transfer of Real Property without Probate CC 15:41 New 07/14 Pro Se Committee Neb. Rev. Stat. §30-24,129 STATE OF NEBRASKA ) ) ss COUNTY OF ________________ ) ( county in which the document will be signed) Affidavit for Transfer of Real Property without Probate I, ________________________________, under penalty of perjury (Nebraska Revised Statute § 28-915), (your name) affirm the following to be true: 1.Thirty days have passed since the death of_____________________________ and I have attached (deceased’s name) to this affidavit a certified or authenticated copy of the death certificate; 2.The deceased is the sole owner of the real property described as ; 3.Based on the assessed value of the real property through the County Assessor/Register of Deeds in the year of death, less real estate taxes and interest on real estate taxes if any is due at the time of death, the value of all the real property in Nebraska belonging to the deceased is $50,000.00 or less and the value of the entire estate (real property value plus personal property value) is $___________________________; 4.There is no Personal Representative, application for Personal Representative, or petition for Personal Representative either pending or granted in another court; 5.I am the ______________________________ of the deceased and am entitled to the real (your relationship to the deceased) property by reason of the homestead allowance, exempt property allowance, family allowance, or by intestate succession pursuant to Nebraska Probate Code § 30-24,129; OR I am entitled to the real property per the will of the deceased and I have made an investigation and have been unable to determine any subsequent will; 6.No other person has a right to the real property; 7.I will file this affidavit with the Register of Deeds Office of the county in which the real property is located ( _________________ County); and 8.I will file the affidavit and certified or authenticated copy of the death certificate in any other county in Nebraska in which the deceased owns real property that is subject to this affidavit. Page 2 of 2 Affidavit for Transfer of Real Property without Probate CC 15:41 New 07/14 Pro Se Committee Neb. Rev. Stat. §30-24,129 Attachment: certified or authenticated copy of Death Certificate __________________________________________ Signature (do NOT sign UNTIL A NOTARY IS PRESENT AND WITNESSES YOU SIGNING) ______________________________________ Date ______________________________________ Address (line 1) ______________________________________ Address (line 2) , This document was acknowledged before me by this day of , 20 . Notary commission expires: Signature of Judge/Clerk of the Court/Notary Public Title : Serial Number ( if any):

Affidavit for Transfer of Real Property without Probate

Nebraska State Court Form CC 15:5 Rev. 03/19 Neb. Rev. Stat. § 77-2018.02(6) CERTIFICATE OF MAILING A NOTICE OF FILING A PETITION FOR THE DETERMINATION OF INHERITANCE TAX IN THE MATTER OF THE ESTATE OF Case No. , Decedent. CERTIFICATE OF MAILING A NOTICE OF FILING A PETITION FOR THE DETERMINATION OF INHERITANCE TAX I/We, , swear or affirm, under the penalties of perjury, that on , pursuant to Neb. Rev. Stat. § 77-2018.02(6), I mailed a notice informing the Nebraska Department of Health and Human Services that I/we have filed a petition for the determination of inheritance tax in the above stated matter. This notice was sent by first class mail, postage prepaid to: Department of Health and Human Services Nebraska Medicaid Estate Recovery P.O. Box 95026 Lincoln, Nebraska 68509-5026 Date: Signature of Petitioner(s) Print or Type Name Street Address/P.O. Box Bar Number and Firm Name (attorneys only) City/State/ZIP Code of Phone Email Address Page 1 of 1 Certificate of Mailing a Notice of Filing A Petition for the Determination of Inheritance Tax CC 15:5 Rev. 03/19

Certificate of Mailing a Notice of Filing a Petition For The Determination of Inheritance Tax

Nebraska State Court Form NOTICE – NO NOTICE TO DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIRED CC 15:5.1 New 02/2016 Neb. Rev. Stat. § 77-2018.02(6) Page 1 of 1 Notice – No Notice to Department of Health and Human Services Required CC 15:5.1 New 02/16 IN THE MATTER OF THE ESTATE OF _____________________________________ , Dec edent. Case No. ____________________ NOTICE – NO NOTICE TO DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIRED Pursuant to Neb. Rev. Stat. § 77-2018.02(6), notice is not required to the Nebraska Department of H ealth and Human Services as the decedent was NOT 55 years of age or older and/or did NOT reside in a medical institution as defined in Neb. Rev. Stat. §68-919(1) at the time of their death. Therefore the petitioner is not required to notify the Nebraska Department of Health and Human Services that a petition for the determination of inheritance tax was filed with this court and is not required to provide a Certificate of Mailing of such. Date: ______________________________________ ____________________________________________ Signature of Petitioner(s) _________________________________________________ P rint or Type Name __________________________________________________ Bar Number and Firm Name (attorneys only) _________________________________________________ P hone __________________________________________________ Str eet Address/P.O. Box __________________________________________________ City/State/ZIP Code __________________________________________________ Email Address

Notice - No Notice to Department of Health and Human Services Required

Nebraska State Court Form AUTHORIZATION TO WITHDRAW WILL CC 15:6 New 03/2017 Page 1 of 1 Authorization to Withdraw Will CC 15:6 New 03/2017 IN THE MATTER OF THE LAST WILL AND TESTAMENT OF . Doc. ___________________ AUTHORIZATION TO WITHDRAW WILL Date: Testator/Testatrix Name Bar Number and Firm Name (attorneys only) Street Address/P.O. Box City/State/ZIP Code Phone Email Address To _____________________County Court, You are hereby authorized to deliver to ________________________________________________ of _________________________________________________, the sealed envelope purporting to contain my last will and testament now deposited in your court. Signature of Testator/Testatrix DO NOT SIGN UNTIL YOU ARE IN THE PRESENCE OF A NOTARY State of ) ) ss. County of ) , This document was acknowledged before me by this day of , 20 . N otary commission expires: Signature of Judge/Clerk of the Court/Notary Public Title : Serial Number (if any):

Authorization to Withdraw Will

ORDER APPOINTING GUARDIAN AD LITEM IN A PROCEEDING UNDER THE NEBRASKA PROBATE CODE Nebraska State Court Form CC 15:7 New 01/17 Neb. Ct. R. § 6-1469 IN THE MATTER OF ____________________________________. Case No. ____________________ ORDER APPOINTING A GUARDIAN AD LITEM IN A PROCEEDING UNDER THE NEBRASKA PROBATE CODE On the court’s own motion, ____________ , is hereby appointed as guardian ad litem for the above-named person pursuant to Neb. Rev. Stat. § 30-4201 et seq. and Neb. Ct. R. § 6-1469. The guardian ad litem appointed herein by this court shall have authority to visit and communicate with the above-named person in executing his or her duties as guardian ad litem. Further, the guardian ad litem shall hav e full legal authority to obtain all information which relates to the above- named party. The guardian ad litem is hereby authorized by this court to communicate verbally or in writing with any agency, organization, person, or institution, including, but not limited to, any school personnel, counselor, or drug or alcohol treatment provider; police department or other law enforcement agency; any probation, parole, or corrections officer; any physician, psychiatrist, psychologist, therapist, nurse, or mental health care provider; any hospital, clinic, group home, treatment group home, residential or mental health treatment facility; any social worker, case manager, or social welfare agency, including the Nebraska Department of Health and Human Services and its employees and administrators; any person or agency or institution charged with caring for the allegedly incapacitated or incapacitated person, ward, protected person, or minor; or any family member, guardian, or any other person. The guardian ad litem is further hereby authorized to obtain from all persons, organizations, or entities, including, but not limited to, those described in the paragraph above, all information, including, but not limited to, the inspection of and obtaining of complete copies of recor ds, reports, summaries, ev aluations, correspondence, written documents, medical records, financial records, or other information, orally or in any media form, which relate to the above-named allegedly incapacitated or incapacitated person, ward, protected person, minor, disabled and/or allegedly disabled person even if such information concerns his or her parents, or any other person or any situation that the guardian ad P age 1 of 2 Order Appointing a Guardian Ad Litem in a Proceeding Under the Nebraska Probate Code. CC 15:7 NEW 01/17 Page 2 of 2 Order Appointing a Guardian Ad Litem in a Proceeding Under the Nebraska Probate Code. CC 15:7 NEW 01/17 litem deems necessary in order to properly represent the allegedly incapacitated or incapacitated person’s, ward’s, protected person’s, and/or minor’s interests. The guardian ad litem shall submit the reports required by Neb. Rev. Stat. § 30-4205 et seq. and Neb. Ct. R. § 6-1469 and shall complete all education requirements under § 30-4202 and § 6-1469. DATED: BY THE COURT: County Judge

Order Appointing a Guardian Ad Litem in a Proceeding Under the Nebraska Probate Code

Nebraska State Court For m REQUIRED Ch. 6, Art. 14, App. 14 New 01/17 Neb. Ct. R. § 6-1469 INITIAL GUARDIAN AD LITEM REPORT IN PROCEEDING UNDER THE NEBRASKA PROBATE CODE IN THE COUNTY COURT OF COUNTY, NEBRASKA Case No. IN THE MATTER OF , Ward/Incapacitated Person. INITIAL GUARDIAN AD LITEM REPORT IN A PROCEEDING UNDER THE NEBRASKA PROBATE CODE I. INFORMATION A. DATES OF INTEREST: The undersigned individual was appointed by the court as the guardian ad litem for the above- named individual as required by Neb. Rev. Stat. § and Neb. Ct. R. § 6-1469. Date of Report: Date of Hearing: Date Completed Training with Judicial Branch Education: B. CONTACTS: I have had the following contact with the following persons in gathering information in the case: Date of Contact Individual Contacted Type of Contact & By Whom (In-person, Phone, Other) C. DOCUMENTS REVIEWED: Date of Document Document Type/Title Page 1 of 4 Initial Guardian Ad Litem Report Ch6Art14App14 New 01/17 Initial Guardian Ad Litem Report Ch6Art14App14 New 01/17 II. GUARDIAN AD LITEM REPORT TO THE COURT A. GUARDIAN AD LITEM NARRATIVE: Based upon information available, the following is a comprehensive outline relating to the allegedly incapacitated person’s ability to make, communicate, or carry out responsible decisions in the areas as required by §§ 30-2619.01 and 30-2619.03(2)(3). The guardian ad litem finds as follows: The ward can cannot select his or her place of abode within or outside this state; The ward can cannot arrange for his or her medical care; The ward can cannot protect his or her personal effects; The ward can cannot give the necessary consents, approvals, or releases; The ward can cannot arrange for training, education, or other habilitating services appropriate to him or her; The ward can cannot apply for private or governmental benefits to which he or she may be entitled; The ward can cannot institute proceedings to compel any person liable for the support of the proposed ward to support him or her if no conservator has been appointed for the proposed ward; The ward can cannot enter into contractual agreements if no conservator has been appointed for the proposed ward; The ward can cannot receive money and tangible property deliverable to him or her and applying such money and property to his or her expenses for room and board, medical care, personal effects, training, education, and habilitative services; and The ward can cannot other area of inquiry the court has directed, which is . Incapacity The ward is incapacitated per . The ward is not incapacitated per . Temporary or Permanent A temporary guardianship is recommended. A temporary conservatorship is recommended. A temporary guardianship and conservatorship is recommended. Page 2 of 4 Initial Guardian Ad Litem Report Ch6Art14App14 New 01/17 A temporary protective order is recommended. A permanent guardianship is recommended. A permanent conservatorship is recommended. A permanent guardianship and conservatorship is recommended. A permanent protective order is recommended. A guardianship is not recommended. A conservatorship is not recommended. A protective order is not recommended. Full or Limited A full guardianship is necessary. A limited guardianship is necessary. If the guardian ad litem has indicated a full guardianship is necessary, please specify why a full guardianship is necessary to protect the best interests of the ward. If the guardian ad litem has indicated a limited guardianship is necessary, please specify what authorities and responsibilities the guardian shall have and what authorities and responsibilities the ward shall have. Page 3 of 4 Click on the "yes" button to remove the lines from the below sections for additional ease in completing this form electronically. Clicking on the "no" button will return the lines. yes no Initial Guardian Ad Litem Report Ch6Art14App14 New 01/17 Please list any concerns regarding any specific matters or problems which, in the opinion of the guardian ad litem, need special, further, or other attention in order to protect or facilitate the ward’s best interests. Additional Comments: Date: Signature of Guardian Ad Litem Print or Type Name Bar Number and Firm Name Street Address/P.O. Box City/State/Zip Code Phone Number Email Address APPENDIX 14 (Neb. Ct. R. – Chapter 6, Article 14) Page 4 of 4

Initial Guardian Ad Litem Report in Proceeding Under the Nebraska Probate Code

Nebraska State Court For m RE QUIRED Ch. 6, Art. 14, App. 15 New 1/17 Neb. Ct. R. § 6-1469 SUBSEQUENT GUARDIAN AD LITEM REPORT IN A GUARDIANSHIP, CONSERVATORSHIP, PROTECTIVE, OR PROBATE PROCEEDING IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF , Ward/Incapacitated Person. I. INFORMATION A. DATES OF INTEREST: Case N o. SUBSEQUENT GUARDIAN AD LITEM REPORT IN A GUARDIANSHIP, CONSERVATORSHIP, PROTECTIVE, OR PROBATE PROCEEDING The undersigned individual was appointed by the court as the guardian ad litem for the above-named individual. Date of Report: Date of Hearing: Type of Hearing: B. CONTACT WITH THE WARD SINCE THE LAST HEARING: I have had the following contact with the ward since the last hearing: Date of Contact Type of Contact & By Whom (In-person, Phone, Other) Page 1 of 5 Subsequent Guardian Ad Litem Report Ch6Art14App15 New 01/17 Click on the "yes" button to remove the lines from the below sections for additional ease in completing this form electronically. Clicking on the "no" button will return the lines. yes no Page 2 of 5 Subsequent Guardian Ad Litem Report Ch6Art14App15 New 01/17 If no contact has been made, please explain why: Expressed preferences of the ward, if any: C. PERSONS AND OTHER RESOURCES CONTACTED SINCE LAST HEARING: Since the date of the last hearing, I have contacted the following persons and/or other resources, including, but not limited to, any physician, psychologist, care provider, clergy member, financial institution, corporation, business entity, or other person with which such person has done or is doing business, in an effort to learn information about the ward’s circumstances and progress: Date of Contact Person or Resource Contacted Title or Agency Name D. DOCUMENTS REVIEWED SINCE LAST HEARING: Date of Document Document Type/Title Page 3 of 5 Subsequent Guardian Ad Litem Report Ch6Art14App15 New 01/17 II. GUARDIAN AD LITEM REPORT TO THE COURT Based upon information available, the following is a comprehensive outline of relevant information and concerns about the ward and his/her situation: III. RECOMMENDATIONS Based upon my contact with the ward, contact with others, and review of documents since the date of the last hearing, if any, and based upon all the files, records, and proceedings related to this matter, the guardian ad litem finds the following: Incapacity The ward is still incapacitated per . The ward is not incapacitated per . Continuation of Temporary or Permanent The temporary guardianship should continue. The temporary conservatorship should continue. The temporary guardianship and conservatorship should continue. The temporary protective order should continue. The permanent guardianship should continue. The permanent conservatorship should continue. The permanent guardianship and conservatorship should continue. The permanent protective order should continue. The guardianship is no longer needed. The conservatorship is no longer needed. The protective order is no longer needed. Page 4 of 5 Subsequent Guardian Ad Litem Report Ch6Art14App15 New 01/17 Full or Limited A full guardianship is still necessary. A full guardianship is no longer necessary. A limited guardianship is still necessary. A limited guardianship is no longer necessary. A limited guardianship is appropriate at this time. If the guardian ad litem has indicated a full guardianship is necessary, please specify why a full guardianship is necessary to protect the best interests of the ward. If the guardian ad litem has indicated a limited guardianship is necessary/appropriate, please specify what authorities and responsibilities the guardian shall have and what authorities and responsibilities the ward shall have. Please list any concerns regarding any specific matters or problems which, in the opinion of the guardian ad litem, need special, further, or other attention in order to protect or facilitate the ward’s best interests. Page 5 of 5 Subsequent Guardian Ad Litem Report Ch6Art14App15 New 01/17 Concerns (cont.) Additional Comments: Signature of Guardian Ad Litem Date: Print or Type Name Bar Number and Firm Name Street Address/P.O. Box City/State/Zip Code Phone Number Email Address APPENDIX 15 (Neb. Ct. R. – Chapter 6, Article 14)

Subsequent Guardian Ad Litem Report in a Guardianship, Conservatorship, Protective or Probate Proceeding

TO THE PERSONAL REPRESENTATIVE OR TRUSTEE: This form is to be filed only with t he Court. Do not send this form to t he i nterested parties. Fill out one form f or eac h deceased or settlor. IN THE COUNTY COURT OF _________________ COUNTY, NEBRASKA THIS DOCUMENT IS CONFIDENTIAL AND S HALL NOT BE MADE PART OF THE COURT FILE OR PROVIDED TO THE PUBLIC PURSUANT TO NEB. CT. R. § 6-1 464. Cas e No.______________ IN THE MATTER OF ________________________. PERSONAL AND FINANCIAL INFORMATION OF PARTIES FOR ESTATES AND TRUSTS Full Name of the Deceased or Settlor: Full Date of Birth of the Deceased or Settlor: Full Social Security Number of the Deceased or Settlor: FINANCIAL INFORMATION OF THE DECEASED OR SETTLOR NAME AND ADDRESS OF FINANCIAL INSTITUTIONS FULL ACCOUNT NUMBER(S) 1.______________________________________________________________________ 2.______________________________________________________________________ 3.______________________________________________________________________ 4.______________________________________________________________________ Instructions: When parties are required to report personal and financial information to the court, the complete information shall be provided on Appendix 8. On pleadings or documents to be filed with the court, financial account numbers, dates of birth, and Social Security numbers, where required, should reference Appendix 8: (i.e., “See Appendix 8”). Financial account numbers should be list ed by the last four digits of the financial account when the account is reported on a pleading or document filed wit h the Court. This form is neither approved nor disapproved by any court or judicial tribunal. Use of this form provides no immunity from error. Nebraska State Court Form PERSONAL AND FINANCIAL INFORMATION OF PARTIES FOR ESTATES AND TRUSTS Page 1 of 1 Personal and Financial Information of Parties for Estates and Trusts Ch6Art14App8 Amn 01/15 CC 15:14 REQUIRED Ch.6, Art.14, App.8 Amn.01/15 Neb. Ct. R. §6-1464(B) Date Signature (s) Name(s) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box Number City/State/ZIP Code Phone E- mail Address Appendix 8 (Neb. Ct. R. – Chapter 6, Article 14) Appendix 8 adopted July 13, 2010; amended August 28, 2013; amended January 22, 2015.

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