TITLE OF CASE CASE NUMBER PROBATE CASE COVERSHEET AND CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO DISTRICT This form is required for all new probate cases filed in the Los Angeles Superior Court. Step 1: In the "Type of Action" column below, select one type of action that best describes the nature of this case by checking a box. Step 2: Across from the "Type of Action" you selected, place an "X" in the column that corresponds to the reason for your choice of district. Note that you may only select from the boxes that are not shaded. District where proposed conservatee, person w/o capacity or minor resides nor or proposed conservatee resides Decedent, conservatee or minor not CA resident but property is in district Other statutory authority (list statute):___________ Or may be filed in Central Dist. per LASC Rule 2.3(b) District where one or more parties resides District where petitioner resides District where decedent resided TYPE OF ACTION (check one) Decedent Estates Petition - Letters of Administration (Initial) [3069] Petition - Probate of Will (Initial) [3075] Petition - Letters of Special Admin w/Gen Powers (Initial) [3070] Petition - Letters of Special Admin w/o Gen Powers (Initial) [3071] Petition/Affidavit - Real Property of Small Value - 13200 PR Code [3001] Spousal/Domestic Partner Property Petition (Initial) [3179] Petition - Determine Succession to Real Prop (Initial) [3301] Petition - Summary Probate (Public Administrator) [3081] Petition to Set Aside Small Estate (Probate Code § 6602) [3292] Conservatorship Petition - Appoint Conservator of Person Only (Initial) [3047] Petition - Appoint Conservator of Estate (Initial) [3046] Petition - Appoint Conservator Estate Nom/Ap (Initial) [3303] Petition - Appoint Conservator of P&E (Initial) [3048] Petition - Appoint Ltd Conservator Person/P&E (Initial) [3198] Guardianship Petition - Appoint Guardian of Person Only (Initial) [3051] Petition - Appoint Guardian of Estate (Initial) [3049] Petition - Appoint Guardian of Person & Estate (Initial) [3050] Trust Petition - Trust/Pursuant Prob Code Sec 17200 (Initial) [3076] Petition ­ Acctg or Order in Crt Created Trust (Initial) [3297] Accounting ­ Trust (initial) [3229] PRO 010 (Rev. 04/17) Confidential Probate Case Cover Sheet ­ Certificate of Grounds for Assignment to District LASC Rule 2.0 American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 3 Principal place of trust administration (Probate Code § 17002) District where proposed conservatee, person w/o capacity or minor resides nor or proposed conservatee resides Decedent, conservatee or minor not CA resident but property is in district District where decedent resided TYPE OF ACTION (check one) Minor's Compromise Petition - Approve Minor's Compromise [3058] Petition - Approve Minor's Compromise (Expedited) [3154] Other Probate Matters Petition ­ Establish Fact of Birth [3065], Death [3066], or Marriage [3067] Other Probate matter (specify): Petition ­ Transaction Where Spouse Lacks Capacity [3082] Petition - Authority to Give Medical Consent w/o Conservatorship [3059] Step 3: Select the appropriate district: Central North (Antelope Valley) The undersigned hereby certifies that the above entitled matter is properly filed for assignment to the District of the Los Angeles Superior Court pursuant to the California Probate Code and Rule 2.3 of this court for the reason checked above. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration was executed on ______________________. (Date) ____________________________________________________ (Signature of Attorney or Self-Represented Party) Step 4: Indicate if person filing this petition will require an interpreter: Yes No If yes, what language? ___________________________________ PRO 010 (Rev. 04/17) Confidential Probate Case Cover Sheet ­ Certificate of Grounds for Assignment to District Page 2 of 3 LASC Rule 2.0 American LegalNet, Inc. www.FormsWorkFlow.com Principal place of trust administration (Probate Code § 17002) Other statutory authority (list statute):___________ Or may be filed in Central Dist. per LASC Rule 2.3(b) District where one or more parties resides District where petitioner resides Step 5: The following information is required for the proposed conservatee, ward, trustor or decedent. Please check the appropriate box for the subject of this case: Conservatee Ward (minor in a guardianship case) Trustor Decedent Other Does the subject of this Petition require an interpreter? Yes No If yes, what language?________________________________ First Name A.K.A(s) Last Name Middle Name Suffix Email Address: Cell Phone (For Text Messaging): I accept service and notices to be delivered to me by [ ] Email [ ] Cell Phone Home address: Street City State Apt./Suite/Unit # Zip Code Mailing Address : Street City ( same as above) Apt./Suite/Unit # State Zip Code IDENTIFICATION (For Minors) Gender: Male Female Date of Birth: mm / dd / yyyyy PRO 010 (Rev. 04/17) Confidential Probate Case Cover Sheet ­ Certificate of Grounds for Assignment to District Page 3 of 3 LASC Rule 2.0 American LegalNet, Inc. www.FormsWorkFlow.com