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: CONSERVATORSHIP OF: SUPPLEMENT TO PETITION FOR APPOINTMENT OF PROBATE CONSERVATOR OF THE PERSON ESTATE CASE NUMBER: HEARING DATE: DEPT.: TIME: Petitioner, (Name) , hereby supplements her/his Petition for Person Estate filed herein Appointment of Probate Conservator of the on (Date) as follows (check all that are necessary to address probate notes): Complete only the numbered items below that are needed to clear probate notes: 1. 2. Re line 1.c(1) of the petition: Bond should be fixed at $ Re line 1.c(3) of the petition: The name and address of the financial institution where blocked account is located is: 3. Re line 1.d. of the petition, list each power requested and the reason needed. Attach additional pages if necessary. The specific orders requested under Probate Code §2590 are: The reason such orders are needed is: The request for orders under Probate Code §2590 is withdrawn. 4. Re line 1.e. of the petition: The specific orders requested under Probate Code Supplement to Petition for Appointment of Probate Conservator PRO 050 02/12 PC 1820, 1821, 2680-2682 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com §1873 or §1901 are: The reason such orders are needed is: The request for orders under Probate Code §1873 and/or §1901 is withdrawn. 5. Re line 1.f. of the petition: The specific orders requested under Probate Code §§2351-2358 are: The reason such orders are needed is: The request for orders under Probate Code §§2351-2358 is withdrawn. 6. 7. Re line 1.k. of the petition: An Attachment Requesting Special Orders Regarding Dementia (California Judicial Council form GC-313) is attached hereto. Re line 1.l. of the petition: The specific other orders requested are: The reason such orders are needed is: 8. 9. Re line 3.e. of the petition: A schedule showing the estimated value and character of the property of the conservatorship is attached hereto as Exhibit A. Re line 3.f. of the petition: A declaration describing the efforts that were made to locate the proposed conservatee's relatives (including, if applicable, the reasons why it was not feasible to contact one or more of them) is attached hereto. 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. Dated: (Signature) Petitioner (Typed Name) Supplement to Petition for Appointment of Probate Conservator PRO 050 02/12 PC 1820, 1821, 2680-2682 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com EXHIBIT A CONSERVATORSHIP PROPERTY Check and complete item 1 only if this petition is for appointment of a successor conservator and the prior conservator filed a complete Inventory and Appraisal. Otherwise, check and complete item 2. 1. Inventory and Appraisal value of cash, bank accounts, and other personal property is $ Specify the dates of all Inventories and Appraisals filed: 2. Estimated value of cash, bank accounts, and other personal property is $ Complete items 3 and 4 in all cases. Enter "0" if your response is zero. 3. Annual gross income from: a. b. c. d. e. f. 4. 5. Real Property Personal Property Pensions Wages Public Assistance Benefits Other $ $ $ $ $ $ $ Total of 1 or 2 and 3: Real Property Check and complete a or b below. a. Real property value per Inventory and Appraisal described in item 1 above Estimated value of real property $ $ b. Supplement to Petition for Appointment of Probate Conservator PRO 050 02/12 PC 1820, 1821, 2680-2682 Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com