ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address): FOR COURT USE ONLY TELEPHONE NO: EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MARIN 3501 Civic Center Drive P.O. Box 4988 San Rafael, CA 94913-4988 (PROPOSED) CONSERVATORSHIP OF: Person Limited Estate of: CASE NUMBER CONFIDENTIAL CONTACT INFORMATION PURSUANT TO Probate Code Sections 2250.6(a)(1)(A)(B)(C), 1826(a)(1)(2), 1851(a) Hearing Date: _______________________________ Proposed Conservator Review Successor Conservator This form must be filed with petitions for the appointment of a conservator, appointment of a successor conservator, and with subsequent accountings. Provide additional pages, if necessary. SPECIAL PROBLEMS RELATED TO INVESTIGATION (i.e. language, personal safety, communication): Please note, the Court must be notified immediately of address changes of Conservatees and Conservators. 1. (PROPOSED) CONSERVATEE: Name: Address: Home No.: _________________________ Work No.: ________________________ Cell No.: Day Program (if appropriate): 2. PETITIONER (if different from Proposed Conservator): Name: Address: Home No.: _________________________ Work No.: ________________________ Cell No.: Relationship to (Proposed Conservatee): 3. (PROPOSED) CONSERVATOR: Name: Address: Home No.: _________________________ Work No.: ________________________ Cell No.: Relationship to (Proposed Conservatee): PR015 (Rev. 6/24/15) CONFIDENTIAL CONTACT INFORMATION Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com THE INFORMATION SOUGHT IN THE BALANCE OF THIS FORM RELATES TO THE PROPOSED CONSERVATEE 4. SPOUSE OR REGISTERED DOMESTIC PARTNER: Spouse Name: Address: Registered Domestic Partner Home No.: _________________________ Work No.: ________________________ Cell No.: 5. RELATIVES WITHIN THE FIRST DEGREE (ADULT CHILDREN, PARENTS): Name: Address: Home No.: _________________________ Work No.: ________________________ Cell No.: Relationship to (Proposed Conservatee): Name: Address: Home No.: _________________________ Work No.: ________________________ Cell No.: Relationship to (Proposed Conservatee): Name: Address: Home No.: _________________________ Work No.: ________________________ Cell No.: Relationship to (Proposed Conservatee): 6. RELATIVES WITHIN THE SECOND DEGREE (SIBLINGS, GRANDPARENTS, ADULT GRANDCHILDREN): Name: Address: Home No.: _________________________ Work No.: ________________________ Cell No.: Relationship to (Proposed Conservatee): Name: Address: Home No.: _________________________ Work No.: ________________________ Cell No.: Relationship to (Proposed Conservatee): Name: Address: Home No.: _________________________ Work No.: ________________________ Cell No.: Relationship to (Proposed Conservatee): PR015 (Rev. 6/24/15) CONFIDENTIAL CONTACT INFORMATION Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 7. RELATIVES PURSUANT TO PROBATE CODE § 1821(b) (ANY OTHER BIOLOGICAL OR LEGAL RELATIVES OF THE CONSERVATEE NOT LISTED ABOVE): Name: Address: Home No.: _________________________ Work No.: ________________________ Cell No.: Relationship to (Proposed Conservatee): Name: Address: Home No.: _________________________ Work No.: ________________________ Cell No.: Relationship to (Proposed Conservatee): 8. NEIGHBORS: Name: Home No.: _________________________ Work No.: ________________________ Cell No.: Name: Home No.: _________________________ Work No.: ________________________ Cell No.: 9. FRIENDS: Name: Home No.: _________________________ Work No.: ________________________ Cell No.: Name: Home No.: _________________________ Work No.: ________________________ Cell No.: 10. FINANCIAL INFORMATION: Type of Trust: Address: City/State/Zip: ____________________________________________________ Home No.: Is there a will? Living Irrevocable Special Needs Approximate Value of Trust: Name of Trustee: Yes No Date the trust/will was established: PR015 (Rev. 6/24/15) CONFIDENTIAL CONTACT INFORMATION Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com