ATTACHMENT PB-4048 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address): TELEPHONE NUMBER: FOR COURT USE ONLY ATTORNEY FOR (Name): Self-Represented 191 North First Street, San José, California 95113 (408) 882-2651 (408) 882-2693 Downtown Courthouse ­ Probate Division SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA COURT ADDRESS: PHONE NUMBER: FAX NUMBER: BRANCH NAME: In the Matter of Conservatorship of the Estate of: Conservatee DECLARATION FOR WAIVER OF ACCOUNTING PROBATE CODE §2628(a) CASE NUMBER: I, , declare that: 1. I am the Conservator for the above-entitled Conservatorship Estate. 2. Pursuant to Probate Code section 2628(a), accountings may be waived when the Estate of the Conservatee at the beginning and termination of the one-year Conservatorship period, if they consist of: a. Property, not including the residence of the Conservatee, of a total net value of less than $15,000.00; and, b. The income of the Conservatee's Estate for each month of the Conservatorship period, not including public benefit payments, is less than $2,000.00; and, c. All of the income of the Conservatee's Estate during the time of Conservatorship period, if not retained, was spent for the benefit of the Conservatee. 3. From the beginning through to the termination of the above-designated Conservatorship, all three of these criteria have been met as to the Conservatee's Estate. I declare under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct. Executed on at , California. (Signature) (Print Name) PB-4048 REV 07/01/12 DECLARATION FOR WAIVER OF ACCOUNTING PER PROBATE CODE §2628(a) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com