Form A dopted for Mandatory Use L - 0 703 ( New April 11, 2019 ) RESPONSE BY ELDERCARING COORDINATOR www.occourts.org ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NO.: NAME: FIRM NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE NO.: FAX NO.: E - MAIL ADDRESS: ATTORNEY FOR (name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE CENTRAL JUSTICE CENTER 700 Civic Center Dr ive West Santa Ana, CA 92701 - 4045 IN THE MATTER OF: RESPONSE BY ELDERCARING COORDINATOR CASE NUMBER: I, (name) , notify the Court and affirm the following: 1. Acceptance: (check one only) I accept the appointment as Eldercaring Coordinator. I decline the appointment as Eldercaring Coordinator. 2. Qualifications: (check one only) I meet the qualifications as an Eldercaring Coordinator recommended by the Association for Conflict Resolution Task Force on Eldercaring Coordination. I do not meet the qualifications recommended by the Association for Conflict Resol ution. However, the parties have chosen me by mutual consent and I believe I can perform the services of an Eldercaring Coordinator because: 3. I am not aware of any conflict, circumstance, or reason that renders me unable to serve as the Eldercaring Coordinator in this matter and I will immediately inform the court and the parties if such arises. 4. I understand my role, responsibility, and authority under the Order Referring Parties to Eldercaring Coordinator dated . I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. DATE PRINTED NAME SIGNATURE OF ELDERCARING COORDINATOR American LegalNet, Inc. www.FormsWorkFlow.com