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4. Information about the Respondent's spouse or adult who has resided with the Respondent for more <br />than six months in the last year: <br />Name: None Relationship to Respondent: <br />Address: <br />City: State: _ Zip Code: Email Address: <br />Home Phone #: Work Phone #: <br />5. Venue for this proceeding is proper in this county because the Respondent <br />Of resides in this county. <br />❑ does not reside in this state, but has property in this county. <br />6. OA Conservator is required because the Respondent is unable to manage property and business affairs <br />because he/she is unable to effectively receive and evaluate information or both or to make or communicate <br />decisions, even with the use of appropriate and reasonably available technological assistance due to the <br />following alleged disabilities or impairments pursuant to §15- 14- 401(1)(b)(1), C.R.S: OPhysician's Letter <br />attached. <br />See attached physician's letter <br />In addition pursuant to §15- 14- 401(1)(b)(11), C.R.5: <br />the Respondent has property which wifl be wasted or dissipated unless proper management is provided. <br />or <br />❑ the Respondent, or persons entitled to the Respondent's support, require money for support, care, <br />education, health, and welfare, and protection, is necessary or desirable to obtain or provide money. <br />7. ❑A Conservator is required to show by clear and convincing evidence that the Respondent is missing, <br />detained, or unable to return to the United States, pursuant to §15- 14.401(1)(b)(1) and (If), C.R.S. The nature <br />of the Respondent's disappearance or detention and any efforts to locate the respondent are as follows: <br />S. If any Power of Attorney exists for financial or medical matters, attach a copy to the Petition, if available. List <br />the agent(s) of the Power of Attorney: <br />Medical Power of Attorney and Financial Power of Attorney both dated April 21, 2006, name Paula Coulter <br />and Paula Coulter and Theodore Coulter, respectively, as attorneys in fact and the same parties as fiduciaries <br />i_n any protective proceeding <br />9. OPetitioner is requesting to be appointed as Conservator or Special Conservator. <br />or <br />❑Petitioner is requesting the following person to act as the Conservator or Special Conservator. <br />Name: Relationship to Respondent: <br />Address: <br />City: State: _ Zip Code: Email Address: <br />Home Phone*: Work Phone #: <br />JDF 876 4108 PETITION FOR APPOINTMENT OF CONSERVATOR FOR ADULT Page 2 of 5 <br />18 <br />