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The Gac103 form serves as a crucial document for individuals seeking to become guardians or conservators for another person in Minnesota. This form is essential for requesting a background study, which helps the court assess whether the proposed guardian or conservator can adequately fulfill their duties in a manner that benefits the person they aim to protect. The form collects vital information about both the proposed protected individual, often referred to as the ward, and the proposed guardian or conservator, including names, addresses, and any relevant licenses they may hold. Background studies mandated by Minnesota statutes delve into the applicant's criminal record, history of maltreatment, and past residence in various states. This thorough screening process is designed to ensure that individuals appointed to these significant roles are reliable and capable. Alongside necessary personal details, the Gac103 form also covers payment structures, privacy rights, and instructions for applicants, emphasizing the accountability and responsibility that accompany positions of power over vulnerable individuals.

Gac103 Example

REQUESTING COURT

COUNTY

COURT FILE NUMBER

PROPOSED PROTECTED PERSON / WARD

FIRST NAME

MIDDLE NAME

LAST NAME

PROPOSED CONSERVATOR / GUARDIAN

FIRST NAME

MIDDLE NAME

LAST NAME

LIST ANY OTHER NAMES BY WHICH THE PROPOSED CONSERVATOR / GUARDIAN HAS BEEN KNOWN

ADDRESS

DATE OF BIRTH mm/dd/yyyy

DRIVERS LICENSE NUMBER (OPTIONAL)

TELEPHONE NUMBER

CITY

STATE

ZIP CODE

SOCIAL SECURITY NUMBER (OPTIONAL)

 

 

 

 

 

 

STATE THAT ISSUED

RACE/ETHNICITY (OPTIONAL)

THE LICENSE

 

 

 

 

 

 

 

 

 

 

 

 

 

M

F

 

 

 

 

GENDER

 

List professional licenses held from the list included in

 

 

 

 

instructions on page 2. Include board name, license

number, and the state that issued the license.

List states other than Minnesota where you have resided for full or partial years (including wintering) within the past ten years: _____________________________________________________________________________

If you listed any states above, this form must be accompanied by classifiable fingerprints. See instructions on page 2.

I give consent to the Minnesota Department of Human Services to conduct a background study on me as provided in

Minnesota Statutes, section 524.5‐118, and to release the results of the study to the court.

SIGNATURE OF PROPOSED CONSERVATOR/GUARDIAN

 

DATE

The Court hereby certifies that this is an in forma pauperis proceeding (person only), and qualifies for exemption from fee payment pursuant to Minn. State. Sec. 524.5‐118, subd. 1 (f) (1). CERTIFIED BY:

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October 2015

GUARDIAN AND CONSERVATOR BACKGROUND STUDY

CONSENT / INFORMATION FORM

BACKGROUND STUDY REQUIREMENT:

Minnesota Statutes, section 524.5‐118, requires a background study on you for the purpose of assisting the court in determining whether your appointment or continued appointment as a guardian or conservator is in the best interests of the ward or protected person. The background study will include:

A review of criminal records held by the Minnesota Bureau of Criminal Apprehension (BCA) and the Minnesota Department of Human Services (DHS);

A review of records of substantiated maltreatment of vulnerable adults or minors held by DHS;

A search of the the databases listed in 524.5‐118 subd. 2a (see item 4 below) to determine if you have ever held a professional license directly related to the responsibilities of a professional fiduciary in Minnesota, and any other state in which you have resided in the past ten years; and

A search of the Federal Bureau of Investigation's (FBI) national criminal records repository if you have resided (including wintering) in any state other than Minnesota in the previous ten years; or if the BCA information indicates you are a multistate offender, or your offender status is undetermined or blank.

NOTIFICATION OF RIGHTS: You have the following rights:

The right to be informed that the court will request a background study on you for the purpose of determining whether your appointment or continued appointment is in the best interests of the ward or protected person;

The right to be informed of the results of the study and obtain from the court a copy of the results; and

The right to challenge the accuracy and completeness of information provided to the court by DHS or BCA by filing a challenge with the appropriate agency under Minnesota Statutes, section 13.04, subdivision 4. Please note that some challenges may be precluded by Minnesota Statutes, section 256.045, subdivision 3.

FEES AND PAYMENTS

The fee for each study is $50 if you have not lived outside of Minnesota in the past ten years. Please note that if the BCA information indicates you are a multistate offender, or your offender status is undetermined or blank, a set of classifiable fingerprints and an additional $30 fee will be required to complete an FBI record search. If this search is required, you will be notified by DHS in writing and the additional payment will be requested at that time.

The fee for each study is $130 if you have resided outside of Minnesota for any period of time during the ten years preceding the background study, and this form must be accompanied by a set of classifiable fingerprints. The $30 fee for processing the fingerprints for the FBI check is included in this fee.

There is no fee for cases approved by the court to proceed in forma pauperis for guardians as provided in Minnesota Statutes, section 524.5‐118. For conservators of the estate, the fee is paid by the estate.

INSTRUCTIONS

1.All information on page 1 of this form is required, unless marked optional. Please type or print legibly.

2.The proposed guardian or conservator must sign and date page 1 of this form.

3.If the proposed guardian or conservator has resided outside of Minnesota in the last ten years (including wintering), this form must be accompanied by a set of classifiable fingerprints. Fingerprint cards can be obtained at the county court administrator's office or by calling the Background Studies Division: 651‐431‐6620.

4.If the proposed guardian or conservator has ever held any of the following licenses, include them in the space provided on page 1: Lawyers Responsibility Board; State Board of Accountancy; Board of Social Work, Psychology, Nursing, Medical Practice, Dentistry, or Marriage and Family Therapy; Department of Education, Commerce, or Human Services; Peace Officer Standards and Training (POST) Board.

5.Mail form with appropriate fee(s) or court verification that the case is proceeding in forma pauperis to:

Department of Human Services

Attn: Guardian Background Studies

PO Box 64172

St. Paul, MN 55164‐0242

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October 2015

Form Characteristics

Fact Name Description
Governing Statute The GAC103 form is governed by Minnesota Statutes, section 524.5-118.
Purpose This form is used to request a background study on a proposed guardian or conservator.
Fees The fee for the background study is $50 for residents who have not lived outside Minnesota in the past ten years.
Fingerprints Classifiable fingerprints must be submitted if the individual has resided outside Minnesota in the last ten years.
In Forma Pauperis No fee is required for cases approved to proceed in forma pauperis.
Background Check Components The study includes a review of criminal records and maltreatment records, among others.

Guidelines on Utilizing Gac103

Once the Gac103 form is completed, it will be submitted to the relevant authorities for processing. This step is essential in ensuring that all necessary information regarding the proposed guardian or conservator is thoroughly reviewed. Please follow the instructions carefully to avoid any delays in your application.

  1. Begin by entering the requesting court county and court file number at the top of the form.
  2. Provide details about the proposed protected person or ward, including their first name, middle name, and last name.
  3. Next, fill in the details for the proposed conservator or guardian. Include their first name, middle name, and last name.
  4. If the proposed conservator or guardian has any other names, list them under List any other names.
  5. Input the address, date of birth (mm/dd/yyyy), and telephone number of the proposed conservator or guardian.
  6. Include the city, state, and zip code of the proposed conservator or guardian's residence.
  7. Add the drivers license number (optional) and social security number (optional) of the proposed conservator or guardian.
  8. Indicate the state that issued the driver’s license.
  9. Fill in the race/ethnicity (optional) and gender of the proposed conservator or guardian.
  10. List any professional licenses held, including the board name, license number, and the state issued.
  11. Enumerate any states of residence other than Minnesota in the past ten years. This includes wintering.
  12. If you have listed any states of residence outside Minnesota, remember to attach a set of classifiable fingerprints.
  13. Provide consent for the Minnesota Department of Human Services to conduct a background study by signing where prompted.
  14. Finally, add the date of the signature and ensure that all information is typed or printed legibly before mailing.
  15. Mail the completed form to the address provided, along with the appropriate fees or a verification that the case is proceeding in forma pauperis.

What You Should Know About This Form

What is the Gac103 form used for?

The Gac103 form, also known as the Guardian and Conservator Background Study Consent / Information Form, is utilized to facilitate the court's evaluation of a proposed guardian or conservator. This assessment ensures that the individual appointed to serve in such responsibilities acts in the best interests of the protected person or ward. The form collects necessary biographical and professional information, as well as consent for a background study mandated by state law.

Who needs to complete the Gac103 form?

Any individual seeking to become a guardian or conservator must complete the Gac103 form. This requirement applies to those who have either been proposed by others or have voluntarily applied for these roles. Completing the form is a crucial step in the court's consideration of their suitability for the position.

What information is required on the Gac103 form?

The form requires various personal details from the proposed guardian or conservator, including their full name, address, date of birth, telephone number, and Social Security number (optional). Additionally, individuals must list any professional licenses held, the states they have resided in for the past ten years, and provide consent for background checks. Some information is mandatory, while others are optional.

What does the background study entail?

The background study involves multiple components aimed at assessing the proposed guardian or conservator's qualifications. It includes a review of criminal records by the Minnesota Bureau of Criminal Apprehension and the Department of Human Services. Furthermore, records of substantiated maltreatment of vulnerable adults or minors will be scrutinized. If the individual has lived outside Minnesota in the past ten years, an FBI background search may also be conducted.

Are there fees associated with the Gac103 form and background study?

Yes, fees apply based on residency history. The study costs $50 if the individual has not lived outside of Minnesota during the last ten years. If they have, the fee increases to $130, inclusive of fingerprint processing. However, if the court approves the case to proceed in forma pauperis (as a person unable to pay court fees), no fees will be charged. For conservators of the estate, the estate covers the costs.

How should the Gac103 form be submitted?

To submit the Gac103 form, complete all required sections and gather any necessary documentation, such as fingerprint cards. This form, along with the correct fees, should be mailed to the Department of Human Services at the specified address on the form. If applicable, include verification that the case is proceeding in forma pauperis. Ensure all information is clear and legible to avoid processing delays.

Common mistakes

Filling out the GAC103 form can seem straightforward, but many individuals make critical mistakes that can delay the process. One common error is illegible handwriting. If the information provided is difficult to read, it may lead to misunderstandings or questions from the court. Entering information in typed format is always preferable.

Another frequent mistake is not including all required information. The form mandates specific details, such as the full names of the proposed guardian or conservator. Failing to include any part of this information, whether it's a middle name or an address, could result in the form being rejected or returned for correction.

Many applicants overlook the need for consent for a background study. By neglecting to sign the consent section, the application cannot move forward. It's essential to check that all signatures are present and clearly written.

Additionally, not providing updated contact information is a mistake that can complicate communication with the court or relevant authorities. Having accurate details, like a current telephone number and address, ensures smooth and timely updates.

When listing previous states of residence, individuals sometimes forget to include all locations where they have lived over the past ten years. This can have significant implications for the background check process. Providing complete information helps avoid delays caused by missing fingerprints or additional requirements.

Including optional information, such as a driver’s license number or social security number, is often misunderstood. Some applicants mistakenly believe this information is mandatory when it is not. Understanding what sections are truly optional can streamline the process.

Lastly, failing to check the fees associated with the background study can create financial surprises. It is essential to understand the fee structure based on residency history and to include the correct payment with the application. This simple oversight could result in unnecessary complications with the court.

Documents used along the form

The Gac103 form is an important document for individuals seeking to become guardians or conservators. When filing this form, you may also need to submit various additional forms or documents to comply with legal requirements. Below is a list of such documents that are commonly used alongside the Gac103 form.

  • Background Study Consent Form: This form gives consent for a background study to be conducted on the proposed guardian or conservator. It assists the court in evaluating the applicant's suitability for the role.
  • Fingerprint Submission Form: Required for applicants who have resided outside Minnesota in the past ten years. This form is used to collect classifiable fingerprints for a national criminal records check.
  • Affidavit of Financial Disclosure: This document outlines the financial status of the proposed conservator. It is crucial for ensuring that the conservator can manage the assets of the ward appropriately.
  • Notice of Hearing: Issued to inform relevant parties of the time and place of the court hearing related to the guardianship or conservatorship case.
  • Proposed Care Plan: This plan describes how the proposed guardian intends to care for the protected person. It includes health, safety, and living arrangements considerations.
  • Request for Court Appointed Attorney: If the proposed protected person cannot afford an attorney, this request can be made for legal representation during the hearing process.
  • Order Appointing Guardian or Conservator: This court document officially designates the individual as guardian or conservator after the court hearing and approval.
  • Acceptance of Appointment: This document must be signed by the proposed guardian or conservator, indicating their willingness to serve in this role if appointed by the court.

Gathering these documents ensures compliance with the requirements of the court and facilitates the process of securing guardianship or conservatorship. It is important to review each document carefully and ensure that all necessary information is provided to avoid delays in the application process.

Similar forms

  • Gac104 Form: This form is used for guardianship proceedings, similar to the Gac103. Both forms collect personal information about the proposed guardian, including background checks and consent for duties associated with guardianship. Officers of the court use them to assess suitability.

  • Gac105 Form: The Gac105 is aimed at conservators. It provides data about financial responsibilities, just as the Gac103 seeks needed information regarding personal guardianship responsibilities. Each form requires details for assessment and background checks.

  • Background Study Consent Form: This document authorizes investigations into the proposed guardian's history. Much like the Gac103, it aims to help the court determine if a person is fit for their role. Consent for a review of criminal records is essential in both cases.

  • Fee Waiver Application: Individuals with financial hardship can submit this form to request fee waivers. Both documents ensure that individuals are assessed fairly and responsibly, facilitating access to the legal process without financial barriers.

Dos and Don'ts

When filling out the GAC103 form, it's important to follow certain guidelines to ensure a smooth process. Below is a list of do's and don'ts.

  • Do: Provide all required information accurately, such as names, addresses, and dates of birth.
  • Do: Sign and date the form where indicated to validate your application.
  • Do: Include any professional licenses you hold that relate to guardianship or conservatorship.
  • Do: Ensure legibility; either type or print clearly to avoid misunderstandings.
  • Don't: Leave any mandatory fields blank; incomplete forms may be rejected.
  • Don't: Forget to include a set of classifiable fingerprints if you've lived outside of Minnesota in the last ten years.
  • Don't: Submit without checking if any fees apply, especially if you are not filing in forma pauperis.
  • Don't: Delay mailing your form; timely submission is crucial for processing your application.

Misconceptions

Misconceptions about the Gac103 form can lead to confusion for those involved in guardianship and conservatorship processes. Below are four common misconceptions, clarified for better understanding.

  • All information provided is optional. Many individuals believe they can skip certain fields on the Gac103 form. However, most information is required unless specifically marked as optional. Providing incomplete information can lead to delays in processing.
  • Fingerprints are always required. Some people think that fingerprints must accompany every Gac103 submission. This is not true. Fingerprints are only necessary if the proposed guardian or conservator has resided outside of Minnesota in the last ten years. If they have remained within Minnesota, submitting fingerprints is not required.
  • Fees apply regardless of circumstances. There is a misconception that every applicant must pay fees for the background study. In fact, there are cases where the court approves proceedings in forma pauperis, which exempts guardians from fees. Conservators may have their fees covered by the estate.
  • The background study is merely a formality. Some individuals think that the background study conducted is a routine check without significant implications. In reality, the study is a critical part of the court's assessment to ensure that the appointment is in the best interests of the proposed ward or protected person. Results can affect eligibility for guardianship or conservatorship.

Key takeaways

Key Takeaways for Using the GAC103 Form:

  • Ensure all required information on page 1 is complete, as incomplete forms may delay processing.
  • Provide accurate details for both the proposed protected person and the proposed conservator or guardian.
  • If you have lived outside Minnesota in the past ten years, include a set of classifiable fingerprints with your submission.
  • Understand that a background study is mandatory for anyone seeking to be a guardian or conservator.
  • The background study will assess criminal records and records of maltreatment involving vulnerable individuals.
  • Be aware of your rights regarding the background study; you have the right to know the results and challenge any inaccuracies.
  • Fees vary: $50 for residents only in Minnesota, up to $130 if you have lived in other states.
  • If you qualify for in forma pauperis status, no fee will be required for guardians, while conservator fees are covered by the estate.
  • Mail the completed form along with the appropriate payment or verification of in forma pauperis status to the Department of Human Services.
  • Keep a copy of the submitted form for your records and for any potential future reference.