GC-112 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: TEMPORARY CONSERVATORSHIP (Name): OF CONSERVATEE EX PARTE APPLICATION FOR GOOD CAUSE EXCEPTION TO NOTICE OF HEARING ON PETITION FOR APPOINTMENT OF TEMPORARY CONSERVATOR of the Person Estate CASE NUMBER: Note to Applicant: Please review the instructions in item 6 on page 3 and at the bottom of that page for completing this form and supporting documents. 1. Applicant (name): a. A petitioner for appointment of a temporary conservator of the b. 2. A proposed temporary conservator. Immediate and substantial harm would be caused to the proposed conservatee, or his or her estate, during the notice period required by Probate Code section 2250(e) because of the following (check all that apply): a. A medical emergency (give a brief description): person estate is of the proposed conservatee. (A medical emergency must be immediate and substantial; treatment must be reasonably unavailable unless a temporary conservator is appointed and cannot wait for the notice period because of the proposed conservatee's pain or extreme discomfort or a significant risk of harm.) b. A financial emergency (give a brief description): c. (A financial emergency must be immediate and substantial. Means other than an exception to notice of hearing on the appointment of a temporary conservator must be shown likely to be ineffective to prevent loss or further loss to the proposed conservatee's estate during the notice period.) Other immediate and substantial emergency (give a brief description): (An emergency must be immediate and likely to cause substantial harm to the proposed conservatee during the notice period.) Page 1 of 3 Form Approved for Optional Use Judicial Council of California GC-112 [New January 1, 2009] EX PARTE APPLICATION FOR GOOD CAUSE EXCEPTION TO NOTICE OF HEARING ON PETITION FOR APPOINTMENT OF TEMPORARY CONSERVATOR (Probate--Guardianships and Conservatorships) Probate Code, § 2250; Cal. Rules of Court, rule 7.1062 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com GC-112 TEMPORARY CONSERVATORSHIP OF (Name): CONSERVATEE CASE NUMBER: 3. Instead of an exception to giving notice to the persons named in item 3c, Applicant requests that (check all that apply): a. The time period of notice to the person or persons named in item 3c be changed as follows (specify number of days of notice or number of hours if less than one day): b. The method of giving notice to the person or persons named in item 3c be changed as follows (specify method of service; for example, personal delivery, fax, or e-mail): c. The person or persons, and his, her, or their relationship to the proposed conservatee are as follows (specify): Name Relationship to proposed conservatee Additional persons and relationships are listed on attachment 3c. 4. An exception to giving notice to the person or persons named below should be made because of the potential harm to the proposed conservatee, or his or her estate, if notice is given (include in this category persons who might not cause harm themselves, but to whom notice should not be given because the notice is likely to bring harm to the proposed conservatee through the actions of another person. State the names and relationships to the proposed conservatee of all persons who should not be given notice): Name Relationship to proposed conservatee Additional persons and relationships are listed on attachment 4. 5. An exception to giving notice to the person or persons named below should be made because Applicant cannot find him, her, or them, despite the exercise of due diligence to search for him, her, or them (state names and relationships to the proposed conservatee of all persons who could not be found): Name Relationship to proposed conservatee Additional person(s) and relationship(s) are listed on attachment 5. GC-112 [New January 1, 2009] EX PARTE APPLICATION FOR GOOD CAUSE EXCEPTION TO NOTICE OF HEARING ON PETITION FOR APPOINTMENT OF TEMPORARY CONSERVATOR (Probate--Guardianships and Conservatorships) Page 2 of 3 GC-112 TEMPORARY CONSERVATORSHIP OF (Name): CONSERVATEE CASE NUMBER: 6. The following documents are presented with this application in support: a. Applicant's Petition for Appointment of Temporary Conservator (form GC-111); b. Supporting declaration of (name): c. d. e. Supporting declaration of (name): Supporting declaration of (name): Supporting declaration of (name): (At least one declaration supporting the grounds for a good cause exception to notice stated in items 2­5 of this application, showing facts within the personal knowledge of the person signing the declaration (or the declaration of an expert witness) is required. See rule 7.1062(e)(2) of the California Rules of Court and Evidence Code sections 800­805. You may use forms GC-112(A-1) and GC-112(A-2) for all supporting declarations.) f. Declaration regarding notice of ex parte application of (name): (This declaration is required with this application. See rules 3.1204(b) and 7.1062(e)(3). g. Other (describe): h. Proposed order. (A proposed order must be submitted with this application. You may use the Order on Ex Parte Application For Good Cause Exception to Notice of Hearing on Petition For Appointment of Temporary Conservator (form GC-115) for the order.) Date: (TYPE OR PRINT NAME OF APPLICANT OR ATTORNEY FOR APPLICANT) (SIGNATURE OF APPLICANT OR ATTORNEY FOR APPLICANT) INSTRUCTIONS 1. Who must be given notice of a hearing on a petition for appointment of a temporary conservator? At least five days' advance notice must be given (1) by personal delivery to the proposed conservatee and (2) by mail or personal delivery to the proposed conservatee's spouse or registered domestic partner and the proposed conservatee's brothers and sisters, parents, grandparents, and children and grandchildren at least 12 years old or the parents, guardians or legal custodians of children or grandchildren under that age. If the proposed conservatee has no spouse or registered domestic partner and none of the relatives listed above, certain other persons must receive notice by mail or personal delivery. If the proposed temporary conservator has no prior relationship with the proposed conservatee, the public guardian of the county