GC-111 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 (Name): CONSERVATEE CASE NUMBER: PETITION FOR APPOINTMENT OF TEMPORARY CONSERVATOR Person 1. Petitioner (name each): Estate Person and Estate HEARING DATE: DEPT.: TIME: requests that a. (Name): (Address and telephone number): be appointed temporary conservator of the PERSON of the proposed conservatee and Letters issue upon qualification. b. (Name): (Address and telephone number): be appointed temporary conservator of the ESTATE of the proposed conservatee and Letters issue upon qualification. c. (1) (2) (3) bond not be required because petition is for a temporary conservatorship of the person only. bond not be required for the reasons stated in attachment 1c. $ bond be fixed. It will be furnished by an admitted surety insurer or as otherwise provided by law. (Specify reasons in attachment 1c if the amount is different from maximum required by Probate Code section 2320 and Cal. Rules of Court, rule 7.207(c).) (4) $ in deposits in a blocked account be allowed. Receipts will be filed. (Specify institution and location): d. e. f. a request for an exception to notice of the hearing on this petition for good cause is filed with this petition. the powers specified in Attachment 1e be granted in addition to the powers provided by law. other orders be granted (specify in attachment 1f). 2. The proposed conservatee is (name): Current address: Current telephone no.: 3. The proposed conservatee requires a temporary conservator to protect property from loss or injury because (facts are provide for temporary care, maintenance, and support specified in attachment 3 as follows): Page 1 of 3 Form Adopted for Mandatory Use Judicial Council of California GC-111 [New July 1, 2008] PETITION FOR APPOINTMENT OF TEMPORARY CONSERVATOR (Probate--Guardianships and Conservatorships) Probate Code, § 2250; Cal. Rules of Court, rules 7.101, 7.1062 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com GC-111 TEMPORARY CONSERVATORSHIP OF (Name): CONSERVATEE CASE NUMBER: 4. Temporary conservatorship is required pending the hearing on the petition for appointment of a general conservator. pending the appeal under Probate Code section 1301. during the suspension of powers of the conservator. Character and estimated value of the property of the estate (complete if a temporary conservatorship of the estate or the 5. person and estate is requested): $ a. Personal property: b. Annual gross income from all sources, including real and $ personal property, wages, pensions, and public benefits: Additional amount for cost of recovery on the bond, calculated as c. $ required under Cal. Rules of Court, rule 7.207(c): d. Total: 6. a. $ Petitioner requests authority to change the proposed conservatee's residence during the temporary conservatorship Petitioner proposes to change the residence of the proposed conservatee to (address): a. b. c. The proposed conservatee will suffer irreparable harm if his or her residence is not changed as requested and no means less restrictive of the proposed conservatee's liberty will suffice to prevent the harm because (reasons are specified in attachment 6a as follows): b. The proposed conservatee must be removed from the State of California to permit the performance of the following nonpsychiatric medical treatment essential to the proposed conservatee's physical survival. The proposed conservatee consents to this medical treatment. (Facts and place of treatment are specified in attachment 6b as follows): 7. a. Petitioner is a professional fiduciary Petitioner holds license no. (specify): from the Professional Fiduciaries Bureau of the Department . . of Consumer Affairs issued or last renewed on (specify later date of initial issuance or renewal): b. c. d. Petitioner was requested to file this petition by (name): The circumstances leading to petitioner's engagement to file this petition are described in attachment 7c. Petitioner had: (1) (2) No relationship to the proposed conservatee, his or her family, or his or her friends before engagement to file this petition. A relationship to the proposed conservatee, his or her family, or his or her friends before attachment 7d. engagement to file this petition. That relationship is described in Petition for Appointment of Probate Conservator (form GC-310) filed with this petition or an attachment to that petition (specify attachment to general petition): the GC-111 [New July 1, 2008] PETITION FOR APPOINTMENT OF TEMPORARY CONSERVATOR (Probate--Guardianships and Conservatorships) Page 2 of 3 GC-111 TEMPORARY CONSERVATORSHIP OF (Name): CONSERVATEE CASE NUMBER: 8. Petitioner's contact with persons named in Petition for Appointment of Probate Conservator a. b. Petitioner is the proposed conservatee. (If this item is selected, go to item 9.) Petitioner is not the proposed conservatee. All persons other than the proposed conservatee named in the Petition for Appointment of Probate Conservator filed with this petition: (1) Have been found and contacted. All will be given notice of the hearing on this petition. (2) Have not been found or have not been contacted. Efforts to find the persons who have not been found and the reasons why any person cannot be contacted are described in one or more declarations under penalty of perjury attached to this petition as attachment 8b. (Attachment 8b is not a request for a good cause exception to notice. See Prob. Code, § 2250(e) and rule 7.1062 of the Cal. Rules of Court.) c. Petitioner is not the proposed conservatee. Facts showing the preferences of the proposed conservatee concerning the appointment of any temporary conservator, and the appointment of the temporary conservator proposed in this petition, or why it was not feasible to ascertain those preferences, are specified in one or more declarations attached to this petition as attachment 8c. 9. Petitioner is informed and believes that the proposed conservatee a. b. c. d. 10. will attend the hearing. is able but unwilling to attend the hearing, does not wish to contest the establishment of a conservatorship, does not object to the proposed conservator, and does not prefer that another person act as conservator. is unable to attend the h