<p>Nomination for oneself of a guardian and* a conservator</p><p>Being of sound mind and not acting under duress, fraud, or undue influence, and in the event a court finds that I require a guardian and/or* conservator, I nominate the person named below to be my (Choose one or both.) [ ] guardian [ ] conservator</p><p>Name</p><p>Address</p><p>City, State, Zip</p><p>Phone</p><p>Email</p><p>Relationship of the nominee to me</p><p>Sign here ► Date</p><p>Executed at: (City and State) Typed or printed name</p><p>*To nominate one person as guardian and a different person as conservator, complete two forms. To nominate co-guardians or co-conservators, complete two forms.</p><p>Utah Code Section 75-5-202.5 Utah Code Section 75-5-311 Utah Code Section 75-5-410</p><p>Nomination of Guardian and/or Conservator – for Approved Board of District Court Judges September 12, 2012 Page 1 of 1 oneself Revised March 3, 2016</p>