NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NUMBER FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURTHOUSE ADDRESS: GUARDIANSHIP/CONSERVATORSHIP OF: CASE NUMBER: REPORT AND PETITION FOR DISPENSING WITH: ACCOUNTING BOND HEARING DATE: DEPT.: TIME: Petitioner is the: guardian of the estate conservator of the estate of . (Name of Minor or Conservatee) 1. 2. Letters: Letters of guardianship/conservatorship were issued to petitioner on . Inventory and Appraisal (complete "a" or "b" below): a. Inventory and Appraisal(s) were filed herein on (Date or Dates) showing the value of the estate to be $ No Inventory and Appraisal has been filed. b. 3. . The balance on hand at the end of the last accounting period was $ Period of Report This report covers the period from inclusive (the "period of the report"). to , 4. Dispensing with Account Petitioner requests an order dispensing with the requirement to account for the period to . Petitioner requests the court dispense with future accounting as long as the conditions specified in Probate Code § 2628(a) are met. Petition Dispensing with Accounting and/or Bond PRO 052 Rev. 02/12 PC 2323 and 2628 Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com 5. Property Values At all times during the period of the report, did the estate consist of property with a total net value of less than $15,000 (not including the value of the minor's or conservatee's residence)? Yes No If yes, describe the estate's property and its value below: Description of Asset Value at Beginning of Report Period Value at End of Report Period 6. Residence Does the estate include a residence owned by the minor/conservatee? Yes No If yes, did the minor/conservatee live in that residence during the entire period of the report? Yes No If no, explain: Petition Dispensing with Accounting and/or Bond PRO 052 Rev. 02/12 PC 2323 and 2628 Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com 7. Income Did the minor or conservatee receive Social Security and/or SSI payments during the period of the report? Yes No Did the minor or conservatee receive income other than Social Security, SSI, or other public benefit payments during the period of the report? Yes No If yes, identify the source and amount of monthly payments below: Describe Source of Monthly Payments Monthly Amount at Beginning of Report Period Monthly Amount at End of Report Period 8. Bond Petitioner requests that the court dispense with the requirement of bond for the guardian/conservator of the estate. During the entire period covered by this report, the estate met the conditions specified in Probate Code § 2628(a). 9. Veterans Administration Benefits The guardianship/conservatorship estate does not receive money from the Veterans Administration, receive revenue or profit from money received from the Veterans Administration, or contain property acquired with money from the Veterans Administration. (Notice to the Veterans Administration is not required.) Petition Dispensing with Accounting and/or Bond PRO 052 Rev. 02/12 PC 2323 and 2628 Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com The guardianship/conservatorship estate receives money from the Veterans Administration, receives revenue or profit from money received from the Veterans Administration, or contains property acquired with money from the Veterans Administration. (Notice to the Veterans Administration is required.) 10. State Hospital The minor or conservatee was not a patient in a state hospital at any time during the period of the account. The minor or conservatee was a patient in, on leave from, or on outpatient status from a state hospital during some or all of the period of the account and notice to the Director of the Department of Mental Health or the Director of the Department of Developmental Services is required. Notice to the Director of the Department of Mental Health or the Director of the Department of Developmental Services is not required because the value of the guardianship/conservatorship estate is less than $1,500, the annual gross income of the guardianship/conservatorship estate is less than $6,000, and the minor or conservatee is not a patient in, on leave from, or on outpatient status from a state hospital. 11. Address The current address of the minor/conservatee is: PRAYER: Petitioner requests that: 1. 2. 3. 4. 5. This report be approved. The court dispense with the requirement of an accounting for the period from to . The court dispense with future accountings provided that the conditions of Probate Code § 2628(b) are met. The court dispense with the requirement of a bond provided that the conditions of Probate Code § 2628(b) are met The court grant such other relief as it deems just and proper. Dated: (Signature) (Typed or Printed Name) Petition Dispensing with Accounting and/or Bond PRO 052 Rev. 02/12 PC 2323 and 2628 Page 4 of 5 American LegalNet, Inc. www.FormsWorkFlow.com VERIFICATION I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct of my own personal knowledge, except as to matters stated on information and belief, and as to those matters I believe them to be true. Executed this day of , 2____, at (City and State) _____. (Signature) Petition Dispensing with Accounting and/or Bond PRO 052 Rev. 02/12 PC 2323 and 2628 Page 5 of 5 American LegalNet, Inc. www.FormsWorkFlow.com