COURT INVESTIGATOR'S OFFICE 125 12th Street, Suite 390 Oakland, California 94607 Telephone: (510) 636-8820 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF ALAMEDA CONSERVATORSHIP OF THE ESTATE OF: conservatee ) ) ) ) ) PROBATE NO.: Declaration of Conservator of the Estate (Sect. 2628) I (we) am (are) the duly-appointed conservator(s) of the estate of the above-named conservatee and declare as follows: 1. The estate, at the beginning and end of the accounting period for which an account is otherwise required, consisted of property, exclusive of the residence of the conservatee, of a total net value of less than fifteen thousand dollars ($15,000). 2. The income of the estate for each month of the accounting period, exclusive of public benefit payments, was less than two thousand dollars ($2,000). 3. All income of the estate during the accounting period, if not retained, was spent for the benefit of the conservatee. I certify under penalty of perjury that the foregoing is true and correct to the best of my knowledge. Dated ________________, at _____________________________________________ CONSERVATOR OF THE ESTATE CONSERVATOR OF THE ESTATE American LegalNet, Inc. www.FormsWorkflow.com