GC-141 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 OF THE (Name): PERSON ESTATE OF CONSERVATEE ORDER APPOINTING TEMPORARY CONSERVATOR CASE NUMBER: WARNING: THIS APPOINTMENT IS NOT EFFECTIVE UNTIL LETTERS HAVE ISSUED. 1. The petition for appointment of a temporary conservator came on for hearing as follows (check boxes c­j to indicate personal presence): a. Judicial officer (name): b. Hearing date: c. d. e. f. g. Time: Dept.: Room: Petitioner (name): Attorney for petitioner (name): Conservatee (name): Attorney for conservatee (name): Conservatee's spouse or registered domestic partner, and relatives (names and relationships): h. Attorneys for persons listed in item g (names and persons represented): i. j. Public Guardian (name): Attorney for Public Guardian (name): THE COURT FINDS 2. a. Notice of time and place of hearing has been given as required by law. b. Notice of time and place of hearing has been modified or dispensed with under Order on Ex Parte Application for Good Cause Exception to Notice on Petition for Appointment of Temporary Conservator filed on (date): 3. It is necessary that a temporary conservator be appointed to provide for temporary care, maintenance, and support protect property from loss or injury a. b. c. 4. pending the hearing on the petition for appointment of a general conservator. pending an appeal under Probate Code section 1301. during the suspension of powers of the conservator. To prevent irreparable harm, the residence of the conservatee must be changed. No means less restrictive of the conservatee's liberty will prevent irreparable harm. Page 1 of 2 Form Adopted for Mandatory Use Judicial Council of California GC-141 [New January 1, 2009] . ORDER APPOINTING TEMPORARY CONSERVATOR (Probate--Guardianships and Conservatorships) Probate Code, §§ 2250­2254 American LegalNet, Inc. www.FormsWorkflow.com GC-141 TEMPORARY CONSERVATORSHIP OF (Name): CONSERVATEE CASE NUMBER: 5. 6. The conservatee must be removed from the State of California to permit the performance of nonpsychiatric medical treatment essential to the conservatee's physical survival. The conservatee consents to this medical treatment. The conservatee need not attend the hearing. THE COURT ORDERS 7. a. (Name): (Address): is appointed temporary conservator of the PERSON of (name): and Letters shall issue upon qualification. b. (Name): (Address): is appointed temporary conservator of the ESTATE of (name): and Letters shall issue upon qualification. 8. a. b. c. Bond is not required. Bond is fixed at: $ Deposits of: $ to be furnished by an authorized surety company or as otherwise provided by law. are ordered to be placed in a blocked account at (specify institution and location): (Telephone): (Telephone): and receipts shall be filed. No withdrawals shall be made without a court order. d. 9. Additional orders in attachment 8c. The temporary conservator is not authorized to take possession of money or any other property without a specific court order. The temporary conservator is authorized to change the residence of the conservatee to (address): 10. The temporary conservator is authorized to remove the conservatee from the State of California to the following address to permit the performance of nonpsychiatric medical treatment essential to the conservatee's physical survival (address): 11. 12. The conservatee need not attend the hearing. In addition to the powers granted by law, the temporary conservator is granted other powers. These powers are specified in attachment 12 below (specify): 13. 14. Other orders as specified in attachment 13 are granted. Unless modified by further order of the court, this order expires on (date): 15. Number of boxes checked in items 7­14: 16. Number of pages attached: Date: JUDICIAL OFFICER SIGNATURE FOLLOWS LAST ATTACHMENT GC-141 [New January 1, 2009] ORDER APPOINTING TEMPORARY CONSERVATOR (Probate--Guardianships and Conservatorships) Page 2 of 2