Alameda County Superior Court Court Investigator's Office Berkeley Courthouse 2120 Martin Luther King, Jr. Way Berkeley, CA 94704 510-636-8820 Fax: 510-451-2269 REQUEST FOR DEFERMENT OF COURT INVESTIGATOR FEES I, ______________________________________(Name of Conservator) am the conservator of the person and/or estate of: Case No.: ________________________________________. I would like to request a waiver or deferment of the Court Investigator fees ordered paid in this matter. The payment of the fees would be a hardship to the conservatee or their estate. The request for waiver or deferment is based on the following information about the conservatee's assets: 1. 2. 3. 4. 5. The conservatee is / is not receiving Medi-Cal benefits. The conservatee's monthly income is $____________. The conservatee's liquid (cash) assets are currently valued at $____________. The conservatee owns / does not own any interest in real property. The conservatee is / is not the beneficiary of a trust. The conservatee's financial interest (Name of Conservatee), in the trust is valued at $_________________. I understand that I have a duty to notify the court of changed circumstances that may affect my eligibility for a deferment of fees. I declare under penalty of perjury under the laws of the State of California that the foregoing information is correct and true. DATE:__________________ SIGNATURE:_________________________________, Conservator BASED ON THE FOREGOING , THE COURT INVESTIGATION FEE IS: Deferred and payable upon the conservatee's death or upon liquidation of property. Waived Other___________________________________________________ Date: ________________ __________________________, Court Investigations Manager CI Revised 1 31 14 American LegalNet, Inc. www.FormsWorkFlow.com