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Here is the text we could read:

Nomination of a conservator for someone else 

Being of sound mind and not acting under duress, fraud, or undue influence, and in the 
event that I die or become incapacitated, I nominate the person named below to be the 
conservator for ___________________________ (name), who is: 

[  ]  a person for whom I am a court-appointed conservator in another jurisdiction 

(Choose all that apply.) 

[  ]  my spouse 

[  ]  my parent 

[  ]  my child 

[  ]  a person for whom I have been nominated as conservator by the will of the 

person’s deceased parent 

[  ]  my relative with whom I have resided for more than six months 

[  ]  a person to whom I am providing care or paying benefits 

elationship of the nominee to me 

elationship of the nominee to the person for whom s/he is 

nominated 

 
Date 

Sign here ► 

 
 

 
Executed at: (City and State) 

 

 
Typed or printed name 

Utah Code Section 75-5-410 

Nomination of Conservator – for someone else 

Approved Board of District Court Judges September 12, 2012 
Revised March 3, 2016 

Page 1 of 1 

ame 

ddress 

hone 

mail 

ity, State, Zip 

  N

  A

  C

  P

  E

  R

  R

Nomination for oneself of a guardian and a conservator

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from legacy.utcourts.gov (2023-03)
Page(s): 1
Fields(s): 23
Average fields per page: 23
Reading Level: Grade 9
LIST Grouping(s): GO-00-00-00-00.

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

name was name_who_is (0.53 conf)
page_field__1 was page_0_field_1 (0.31 conf)
choose_apply was choose_all_that_apply (0.37 conf)
page_field__2 was page_0_field_3 (0.31 conf)
users1_name__1 was name (1.00 conf)
users1_address_line_one was address (1.00 conf)
city_state_zip was city__state__zip (0.35 conf)
users1_phone_number was phone (1.00 conf)
email was email (0.38 conf)
relationship_nominee was relationship_of_the_nominee_to_me (0.42 conf)
relationship_nominee_person was relationship_of_the_nominee_to_the_person_for_whom_s_he_is (0.37 conf)
users1_signature was sign_here (1.00 conf)
signature_date was date (1.00 conf)
users1_name__2 was typed_or_printed_name (1.00 conf)
executed_city_state was executed_at_city_and_state (0.45 conf)
page was page_1_of_1 (0.42 conf)
court_appointed_jurisdiction was a_person_for_whom_i_am_a_court_appointed_conservator_in_another_jurisdiction (0.48 conf)
spouse was my_spouse (0.42 conf)
parent was my_parent (0.42 conf)
child was my_child (0.42 conf)
person_nominated_conservator was a_person_for_whom_i_have_been_nominated_as_conservator_by_the_will_of_the (0.41 conf)
relative_resided_six_months was my_relative_with_whom_i_have_resided_for_more_than_six_months (0.37 conf)
person_care_benefits was a_person_to_whom_i_am_providing_care_or_paying_benefits (0.39 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Nomination for oneself of a guardian and a conservator

About This Form:

Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02