In the complex realm of legal guardianship and conservatorship proceedings, the Gac103 form emerges as a crucial document, mandated by the state of Minnesota, designed to facilitate a thorough background study of individuals proposing to assume these critical roles. This form, officially known as the Guardian and Conservator Background Study Consent/Information Form, is a linchpin in safeguarding the interests and welfare of wards or protected persons by ensuring that proposed guardians or conservators are suitable for their roles. It encompasses a series of personal information requests, including but not limited to, names, addresses, social security numbers, professional licenses, and residential history, aiming to compile a comprehensive profile of the candidate. Of particular note is its requirement for classifiable fingerprints from candidates who have lived outside Minnesota within ten years preceding their application, underscoring the form's role in facilitating multi-state criminal and professional background checks. This scrutiny is further intensified by the inclusion of a consent clause, allowing the Minnesota Department of Human Services to conduct these background studies in alignment with Minnesota Statutes, section 524.5‐118. Moreover, the form is instrumental in notifying applicants about their rights throughout the process, including the right to be informed about the study's outcomes and the provision to challenge its findings, thus embodying a blend of rigorous vetting procedures and adherence to principles of fairness and transparency. The financial commitments involved, varying based on residency history and the nature of the proceeding, highlight the state's commitment to a thorough examination while considering the financial capabilities of the individuals involved. Therefore, the Gac103 form not only serves as a gateway to potentially assuming the mantle of a guardian or conservator but also as a safeguard ensuring that those who undertake these roles have undergone a rigorous scrutiny process for the ultimate benefit of the vulnerable individuals they seek to protect.
| Question | Answer |
|---|---|
| Form Name | Form Gac103 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | minnesota background check form, DHS, GAC103, 2003 |
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)
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STATE THAT ISSUED |
RACE/ETHNICITY (OPTIONAL) |
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THE LICENSE |
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GENDER |
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List professional licenses held from the list included in |
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instructions on page 2. Include board name, license |
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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 |
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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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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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