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10. Did the Respondent nominate a Conservator pursuant to §15-14 -413, C.R.5.7 ©Yes ONo if Yus, <br />Identify: <br />Paula Coulter (the Petitfonor herein) 4041 Field St., Lakewood, CO 80215 (303) 238 -9197 and <br />Theodore Coulter, 19210 Lovers Lane, Grey Forest, TX 78023 (210) 695 -6994 <br />The nominee is 21 years of age or older. State relationship to Respondent: <br />'Mnominated in writing by Respondent. ❑spouse. Elparent. [Radult child. <br />M,agent under power of attorney. Oaduft with whom respondent has resided. <br />Mother. sole 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 maximum self - reliance and <br />independence. <br />11. Are you requesting the powers and duties to be Duniimitedlunrestricted or ❑iimitedtwith <br />restrictions? Provide information below to support your request. List the property to be placed under the <br />Conservators control and ldentify tlrnitatlonslrestrictions on the Conservator's powers and duties, as <br />appropriate. <br />ResRundent is sinnificanfly damentedw.11b wArsening marngy and physical functioning. She is Incapable of managing <br />her medical and #financial affairs. All funds belonging or created by Respondent irrespective of the curranttitilbG_of <br />accounts MI bB yfaced wfihin the Conservators control without limitation <br />12. Sections a and b below identify assets and the source and amount of 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- 14- 403(2)(g), G.R.S. <br />a. Does the Respondent have any assets, e.g. bark accounts, property? MYes ❑No <br />Description of Assets, e.g. Bank Accounts, Property <br />Amount of <br />Anticipated income <br />or Receipts <br />Bank,. Account <br />$ 1,200.00 monthly <br />Balance or Estimated_ <br />Value of Property <br />Smith Bame Accounts ' "" ' <br />a raximatet <br />$ 359,aoa.a0 <br />Wells Fargo accounts • <br />apprwimately <br />22 000.00 <br />Canon National Bank accounts <br />a roxitnatel <br />3,000.00 <br />Southfield hind & Mining Company,___ <br />Unknown <br />Members Federal Credit Union accounts <br />approximate <br />27,004.00 <br />Janus Account , <br />a roximatel, <br />-� <br />_ - 3 700.00 <br />Larimer Count ro Q <br />_�.__ <br />unknown <br />Totali T - <br />$ 417 000.01) <br />b. Does the Respondent have any anticipated income, e.g. Social Security, interest? ®Yes ❑No <br />Descrip #ion of Income e.g. Social Security, interest, insurance proceeds <br />Amount of <br />Anticipated income <br />or Receipts <br />Social Security <br />$ 1,200.00 monthly <br />Total <br />$ 1,200.00 months <br />