SUPERIOR COURT, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA RIVERSIDE 4050 Main Street, Riverside, CA 92501 RIVERSIDE FAMILY LAW 4175 Main Street, Riverside, CA 92501 HEMET 880 N. State St., Hemet, CA 92543 PALM SPRINGS 3255 Tahquitz Canyon Way, Palm Springs, CA 92262 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY FAX NO. ( Optional): TELEPHONE NO: E MAIL ADDRESS ( Optional ) ATTORNEY FOR ( Name): PETITIONER: CASE NUMBER: IN THE MATTER OF THE CONSERVATORSHIP GUARDIANSHIP OF: DECLARATION IN SUPPORT OF ORDER DISPENSING WITH ACCOUNTING (PROBATE CODE § 2628) Date of Hearing: Time: Department: 1. I/We, collectively referred to as “Petitioner,” declare and state that if called as a witness(es) in this matter, I/We would testify as follows based upon my/our own personal knowledge. 2. I/We am/are the Conservator / and was appointed on Letters of Conservatorship / 3. Guardian of the Person . Estate of Letters of Guardianship have been issued. An Inventory and Appraisal was filed on (Date) 4. Conservatee/Ward has no assets / has assets valued at $ Conservatee/Ward receives the following monthly income: Source of Income (e.g., pension, social security) Monthly Amount $ $ $ $ Total: Form #RI-P33 (Rev. 07/20/2010) $ DECLARATION RE DISPENSING WITH ACCOUNTING Page 1 of 2 RI-P33 American LegalNet, Inc. www.FormsWorkFlow.com , SHORT TITLE: CASE NUMBER: 6. Neither the source nor amount of Conservatee’s/Ward’s monthly income is expected to change, except for automatic cost of living adjustments. If Conservatee’s/Ward’s monthly income does change, petitioner will file a declaration with the court explaining the changes. 7. Conservatee’s/Ward’s estate does or does not include income or property from the Veteran’s Administration, either directly, or as income or interest on money received from the Veteran’s Administration. 8. All of Conservatee’s/Ward’s income, if any, was used for Conservatee’s/Ward’s benefit, care, and or needs. 9. Conservatee’s/Ward’s estate at the beginning and end of the accounting period, for which an account is otherwise required, consisted of property that did not exceed a total net value of fifteen thousand dollars ($15,000), excluding Conservatee’s residence. 10. Conservatee’s/Ward’s income during each month of the accounting period, excluding public benefits, was less than two thousand dollars ($2,000). 11. For the reasons stated herein, I/We request that the accounting requirement be dispensed with. I/We declare under penalty of perjury under the laws of the State of California, that the foregoing is true and correct. Date: Conservator/Guardian (TYPE OR PRINT NAME) SIGNATURE OF CONSERVATOR/GUARDIAN Date: Conservator/Guardian (TYPE OR PRINT NAME) Form #RI-P33 (Rev. 07/20/2010) SIGNATURE OF CONSERVATOR/GUARDIAN DECLARATION RE DISPENSING WITH ACCOUNTING Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com