Attorney or party without attorney (Name, State Bar number, and address) FOR COURT USE ONLY ATTORNEY FOR (Name): Insert name of court, judicial district or branch court, if any and post office and street address SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE Riverside: 4050 Main St. (P.O. Box 431), Riverside, CA 92502-0431 Indio: 46-200 Oasis St., Indio, CA 92201 Hemet: 880 N State St., Hemet, CA 92543 Name of petitioner: Case Number: Declaration of Petitioner regarding Conservatorships/Trusts, Trust Accounts, Conservator as Trustee and Court Jurisdiction of Trust. At the filing of a Petition for Conservatorship of an Estate, the petitioner shall advise the Court if the proposed conservatee is the settlor of a pre-existing trust, wherein the proposed Conservatee is a beneficiary of such trust. The petitioner shall also advise the Court of whether the proposed Conservator of the Estate is a trustee of said trust. Rule 6.1205 ATTENTION DO NOT ATTACH THIS FORM TO THE TRUST INSTRUMENT I Disclose to the Court that: Petitioner 1. The proposed conservatee is is not the settlor of a pre-existing trust, wherein the proposed conservatee is a beneficiary of such trust. 2. The proposed conservator of the estate trust. is is not the trustee or successor trustee of said I declare under the penalty of perjury under the laws of the State of California that the above information is true and correct. This Declaration is signed on (Date) (Type or print name of petitioner) (Signature) DECLARATION OF PETITIONER REGARDING CONSERVATORSHIP/TRUST, TRUST ACCOUNTS, CONSERVATOR AS TRUSTEE AND COURT JURISDICTION OF TRUST RULE 6.1205 RI-P27 American LegalNet, Inc. www.FormsWorkflow.com