ATTACHMENT PB-4062 ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS) TELEPHONE NUMBER: FOR COURT USE ONLY ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CONSERVATORSHIP 191 North First Street 191 North First Street San José, California 95113 Downtown Courthouse - Probate Division PERSON ESTATE OF (Name):: _______________________________________________________________ PROPOSED CONSERVATEE CONSERVATORSHIP STIPULATION AND PROPOSED ORDER Modification 1. a. b. Not based on a hearing Today's Hearing (date) CASE NUMBER: DEPARTMENT: 2. Judge: 3. Parties/Attorneys: a. b. c. d. e. Petitioner present Proposed Conservator present Proposed Conservatee present Other party present Other party present Petitioner's attorney present: Proposed Conservator's attorney present: Proposed Conservatee's attorney present: Other party's attorney present: Other party's attorney present: 4. The parties agree/stipulate that the provisions listed on the attachment(s) to this form become Court orders. 5. Number of attached pages: 6. Previous Orders that are not inconsistent with the orders herein shall remain in full force and effect. PB-4062 REV 01/01/13 CONSERVATORSHIP STIPULATION AND PROPOSED ORDER Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com ATTACHMENT PB-4062 PETITIONER: RESPONDENT: CASE NUMBER: 7. We have read this entire Stipulation and Order, including all Attachments. We understand the terms of the Stipulation fully, and ask that the Court make our stipulation the court orders. We give up the right to all further notice of this order. Date: Petitioner Date: Attorney for Petitioner Date: Proposed Conservator Date: Attorney for Proposed Conservator Date: Attorney for Proposed Conservatee Date: Other party: Date: Other party: 8. Interpreter Witness Declaration Interpreter: The Petitioner Proposed Conservator Proposed Conservatee is unable to read or understand this Stipulation and Order and its attachments because: a. b. 9. his/her primary language is (specify): other (specify): Other party I certify under penalty of perjury under the laws of the State of California that I have, to the best of my ability, read or translated for the Petitioner Proposed Conservator Proposed Conservatee Other party this Stipulation and Order including all attachments. He or she said they understood this Stipulation and Order and its attachments before signing them. Date Interpreter's printed name Interpreter's signature ORDER 10. The Court approves the terms stipulated and agreed to in this document and all attachments, and makes them court orders. Date: Judicial Officer of the Superior Court PB-4062 REV 01/01/13 CONSERVATORSHIP STIPULATION AND PROPOSED ORDER Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com