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10. Did the Respondent nominate a Conservator pursuant to §15 -14 -413, C.R.S.? ❑Yes ONo If Yes, <br />Identify: <br />Paula Coulter (the Petitioner herein) 1041 Field St., Lakewood, CO 80210 (303) 238 -9197 and <br />Theodore Coufter, 1:)210 Lovers Lane, Grey Forest, TX 78023 (210) 695 -6994 <br />The nominee is 21 years of age ur older. State relationship to Respondent: <br />'O.naminated in walking by Respondent, ❑spouse. Uparent. Nadult child. <br />'0agent under power of attorney. ❑adult with whom respondent has reslded. <br />;Mother: sale financial agent for protected person for last six (6) years <br />The Court, whenever feasible. shall grant to a conservator only those powers necessary based <br />on the protected person's limitations and demonstrated needs and will issue orders that will <br />encourage the development of the protected person's maximuln self - reliance and <br />independence. <br />11. Are you requesting the powers and duties to be ®uniimitedlunrestActed or ❑iimitedlwith <br />restrictions? Provide information bal-ow to support your request. list the property to be placed under the <br />Conservator's control and Identify Ifrn tatlonsfrestriMons on the Conservator's pc"rs and duties, as <br />appropriate. <br />12- Sactln s a and b below identify assets and the source and amount cf anticipated income or receipts (public <br />benefits, income, houses, real property, proceeds from insurance policy as beneficiary, proceeds from <br />pension as beneficiary, etc,), together with an estimate of the value, including any insurance or pension. <br />pursuant to §15- 14103(2)(9), Q.R,& <br />a. does the Respondent have any assets, e.g. bank accounts, m MYes ❑N4 <br />; <br />.Deiscrl ptio n of Assts, e.g. Bank Accounts; Property <br />Amount of ; <br />Antirtpa . Income <br />or Recell is <br />Bank—.- Account` <br />Balande or Estii0ated <br />Value-of .Pro rt <br />Smith Barney accounts <br />approximately <br />$ 309,000.00 <br />Wells Fargo accounts <br />approximately <br />22 000.00 <br />Canon National bank accounts ' - MW , <br />approximately <br />3,000.00 <br />Southfield Land & Mining Company <br />$ 1 200.00 month) <br />Unknown <br />Members Federal Credit Chinn accounts <br />approximately <br />27,000.00 <br />Janus Account ' <br />approximate <br />3,700.00 <br />Larirmer County promly <br />Unknown <br />Total. ` . <br />$ 417,000.00 <br />b. Goes the Respondent have any anticipated income, e.g. Sooial Security, interest? ®Yes 0 N <br />Description of Income 9.9. Speial Security, )merest,. insurance proceeds <br />y - -;, :: <br />Amount of ; <br />Antirtpa . Income <br />or Recell is <br />Social Security <br />$ 1,200.00 monthly <br />Total <br />$ 1 200.00 month) <br />19 <br />