CI-123 ATTORNEY OR PARTY WITHOUT ATTORNEY NAME: FIRM NAME: ADDRESS: CITY: E-MAIL ADDRESS (OPTIONAL): ATTORNEY FOR (NAME): STATE: ZIP CODE: TELEPHONE NO: FAX NO. (OPTIONAL): STATE BAR NO: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF MONTEREY Monterey Division 1200 Aguajito Road Monterey, California 93940 Conservatorship Guardianship of Person Estate of CASE NUMBER: REFERRAL TO COURT INVESTIGATOR -- CONFIDENTIAL Complete and file with initial petition, each accounting, and when any party changes residence. Note: A fee may be assessed for Court Investigator Services ­ See Probate Code §1851.5 Hearing Date: This referral is being sent to the Probate Investigator's Office for an investigation regarding (check all that apply): Appointment Medical Powers Sale of (former) Residence Accounting/ Review Dementia Powers Substituted Judgment Termination Other: (Specify) Information about the (Proposed) CONSERVATEE: (Proposed) Conservatee's CURRENT address: Address: Phone number: (Proposed) Conservatee's HOME address: Address: Phone number: Birth Date: Social Security Number: Marital Status: Single/Divorced Widowed Married Registered Domestic Partner Yes No Special Needs (i.e. language)? Is (proposed) conservatee under an LPS Conservatorship now? If yes, LPS #: (Proposed) Conservatee's Attorney (name): Address: Phone number: Fax number: (The reverse side may be used for additional information, if desired) Form Approved for Mandatory Use CI-123 Rev. September, 2013 REFERRAL TO COURT INVESTIGATOR -- CONFIDENTIAL (CIVIL) Monterey County Superior Court Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com CI-123 CONSERVATORSHIP OF (NAME): Information about the (Proposed) CONSERVATOR: All proposed Conservators must complete the information on this page. If there is more than one proposed Conservator, attach a copy of this page for each person. CASE NUMBER: Person Name: Address: Daytime Phone: Relationship to Conservatee/ward: Date of Birth: Social Security Number: Driver's License Number: Work Phone: Cell Phone: Attorney: Attorney's Address: Attorney's Phone: Attorney's Fax: Estate I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Information sheet(s) for (number) Signature of Proposed Conservator of (proposed) co-conservators is attached. Form Approved for Mandatory Use CI-123 Rev. September, 2013 REFERRAL TO COURT INVESTIGATOR -- CONFIDENTIAL (CIVIL) Monterey County Superior Court Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com CI-123 CONSERVATORSHIP OF (NAME): CASE NUMBER: Information about the (Proposed) Conservatee's Relatives & Friends: List the spouse or registered domestic partner, 1st and 2nd degree relatives (these are parents, children, brothers/sisters, grandparents and grandchildren), neighbors and close friends of the (proposed) conservatee. Name: Relationship to (proposed Conservatee: Home Address: Home Phone: Name: Relationship to (proposed Conservatee: Home Address: Home Phone: Name: Relationship to (proposed Conservatee: Home Address: Home Phone: Name: Relationship to (proposed Conservatee: Home Address: Home Phone: Name: Relationship to (proposed Conservatee: Home Address: Home Phone: Name: Relationship to (proposed Conservatee: Home Address: Home Phone: Name: Relationship to (proposed Conservatee: Home Address: Home Phone: Form Approved for Mandatory Use CI-123 Rev. September, 2013 Work Phone: Cell Phone: Work Phone: Cell Phone: Work Phone: Cell Phone: Work Phone: Cell Phone: Work Phone: Cell Phone: Work Phone: Cell Phone: Work Phone: (CIVIL) Cell Phone: Monterey County Superior Court Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com REFERRAL TO COURT INVESTIGATOR -- CONFIDENTIAL