Declaration Of Service
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Declaration Of Service Form. This is a California form and can be use in Orange Local County.
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Tags: Declaration Of Service, LPS-4, California Local County, Orange
PETITIONER (Name & Address):
TELEPHONE NO.:
FOR COURT USE ONLY
IN PROPRIA PERSONA
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
Lamoreaux Justice Center
341 The City Drive
Post Office Box 14171
Orange, CA 92863-1571
CONSERVATORSHIP OF:
CONSERVATEE
DECLARATION OF SERVICE
CASE NUMBER:
LPS
I, the undersigned, hereby declare that I gave or mailed a copy of the Petition for Reappointment of Conservator and Notice
of Hearing as follows:
1.
Mailed
Date:
Gave
2.
Mailed
Date:
Gave
3.
Mailed
Date:
Gave
4.
Mailed
Orange County Health Care Agency
Mental Health Director
th
405 West 5 Street, Suite 458
Santa Ana, CA 92701
Orange County Public Administrator/ Public Guardian’s Office
P.O. Box 11526
Santa Ana, CA 92711
Office of the Public Defender
Mental Health Unit
901 W. Civic Center Dr., Suite 200
Santa Ana, CA 92703
Date:
Conservatee:
Address:
Date:
Facility:
Address:
Gave
5.
Mailed
Gave
6.
Mailed
Date:
Gave
[Any others, such as private attorney for conservatee]
Name:
Address:
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
►
(TYPE OR PRINT NAME)
LPS-4 (Revised June 1, 2008)]
984 (R6/08)
(SIGNATURE OF CONSERVATOR)
DECLARATION OF SERVICE
(LPS Conservatorship Reappointment)
DEC 399
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