Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Final Report On Waiver Of Account Of Conservator And Petition For Approval Of Report Form. This is a California form and can be use in Sacramento Local County.
Tags: Final Report On Waiver Of Account Of Conservator And Petition For Approval Of Report, PR-E-LP-029, California Local County, Sacramento
1
ATTORNEY’S NAME OR PETITIONER NAME IN PRO PER
ATTORNEY’S BAR NUMBER:
2
STREET ADDRESS:
3
CITY, STATE, ZIP CODE:
4
TELEPHONE NUMBER:
FAX:
EMAIL:
5
6
IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA
7
IN AND FOR THE COUNTY OF SACRAMENTO
8
9
10
No.
11
12
Conservatorship of the ( ) person and
( ) estate of:
13
14
15
Dept. 129
In re:
_____________________, Conservatee
(state name)
FINAL REPORT ON WAIVER OF
ACCOUNT OF CONSERVATOR AND
PETITION FOR APPROVAL OF REPORT,
( ) AND FOR APPROVAL OF
CONSERVATOR’S FEES
( ) AND ATTORNEY’S FEES
( ) AND FOR DISTRIBUTION OF ASSETS
ON HAND
( ) OTHER (State):
16
17
18
19
Hearing Date:
Time:
Calendar No.:
20
21
22
23
24
Petitioner, ___________________, respectfully represents:
(Name)
1. Appointment. On __________, Petitioner was appointed as
(Date)
25
Conservator of the person/estate of ____________________. The Letters of
26
Administration were issued on _________. At all times since the appointment,
(Date)
27
Petitioner has been acting as the Conservator.
(Name)
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-1Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
1
2
3
4
5
6
2. The conservatorship is no longer necessary because (check applicable box):
( ) the conservatee is deceased, having passed away on: __________;
(Date)
( ) The assets of the estate have been exhausted and there are no longer any
assets remaining which would require a conservatorship;
7
( ) The conservatorship has been terminated by the court;
8
( ) Other (state reason):
9
3. Period of Report. The report covers the period beginning ___________ and
(Date)
10
11
ending ___________.
(Date)
12
13
4. Inventory and Appraisement. The Inventory and Appraisement was filed on:
__________, showing the value of the estate to be: $ __________.
(Date)
14
15
16
17
18
19
20
21
22
23
24
25
Supplemental Inventory and Appraisements was filed on: __________, stating the
value of assets to be: $ ___________.
5. Final Account not Required. The final accounting is not required because (check
applicable box):
( ) The former conservatee has been restored to full capacity and has filed a waiver
of account (Attach waiver as Exhibit “1”).
( ) The court has previously ordered accounts are not required pursuant to Probate
Code Section 2628 and the conditions of that section continue to exist.
( ) The conservatee is deceased and all persons entitled to receive distribution of
the estate have filed a waiver of accounting. (Attach waivers of account as Exhibit
“1”) Note if petitioner is also the personal representative or trustee, then the heirs,
devisees, and trust beneficiaries must sign the waiver of account.
26
27
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-2Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
1
2
3
4
5a. Financial Account Statements. Note: The conservator must attach an original
5
account statement stating value for any asset held at close of this accounting
6
period from the following type of financial institution: insurance company, broker or
7
agent, investment company or bank, securities broker-dealer, investment
8
advisor or financial planner, bank trust, savings and loan, industrial bank or
9
credit union. Check the applicable box:
10
11
12
( ) Petitioner has attached the required financial institution statements on Exhibit
“2”.
( ) Petitioner has filed herewith a separate affidavit captioned “Confidential
13
Financial Statement” with attached financial institution statements containing
14
confidential information.
15
16
6. Interest Bearing Accounts. If applicable, check the box: ( ) All the cash was
17
invested and maintained in interest bearing accounts or in investments authorized by
18
law or the governing instrument, except for an account of cash that was reasonably
19
necessary for the orderly administration of the estate.
20
21
7. Sales, Purchases, Change in form of assets. During the period of this report; sales,
22
purchases or change in form of assets ( ) did ( ) did not occur. If in the
23
affirmative, describe the transactions.
24
25
26
27
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-3Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
1
2
8. Property on Hand. The property on hand for distribution is set forth in Exhibit “3”..
3
9. Liabilities of the Estate. There ( ) are ( ) are not any outstanding debts (includes
4
tax due, notes payable, court judgments) at the end of the accounting period. If in
5
the affirmative, describe the debts, date of creditor claim, amount owed, terms:
6
7
8
9
10
11
12
13
10. Bond Report.
14
Fair Market, Value of Assets (do not include real property) : $ ___________
15
Annual Income or Receipts from all sources:
$ ___________
16
Total Bondable Estate:
$ ___________
17
18
Current Bond:
$ ___________
19
Current Assets in Blocked Account: $ ___________
20
Total:
$ ___________
21
22
Petitioner requests:
23
( ) Additional Bond:
24
( ) Reduction in Bond: $ ______________
25
( ) No change in amount of bond.
26
( ) Additional assets be ordered blocked as follows (state amount, financial
27
$ ______________
institution):
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-4Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
1
11. Family or Affiliate Relationship.
2
There ( ) were ( ) were not any family or affiliate relationships between the
3
fiduciary and any agent hired by the fiduciary during the accounting period. If in the
4
affirmative, describe.
5
6
12. Veteran’s Administration.
7
The conservatee ( ) was ( ) was not entitled to receive Veteran’s Administration
8
Benefits.
9
10
13. State Hospital.
11
The conservatee ( ) was ( ) was not a patient on leave of absence from a state
12
hospital.
13
14
14. Testate/Intestate.
15
If conservatee is deceased, check applicable box: ( ) conservatee died with a
16
( ) Will ( )Trust; ( ) conservatee died without a ( ) Will ( )Trust.
17
18
15. MediCal Benefits.
19
If conservatee is deceased, check applicable box: conservatee ( ) did ( ) did not
20
receive Medi-Cal Benefits.
21
22
23
24
25
26
27
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-5Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
1
2
16. Person Entitled to Notice.
3
A request for Special Notice ( ) has ( ) has not been filed. If in the affirmative list
4
name and address of person (1) requesting Special Notice:
5
Name
Address
Adult/Minor
Relationship
6
7
8
9
10
List all persons entitled to notice of the hearing on the petition, state name, address, &
11
relationship to decedent of all heirs at law, beneficiaries of a Will or trust, named
12
executors of a Will, named trustees of a trust.
13
Name
Address
Adult/Minor
Relationship
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-6Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
1
2
3
4
17. Distribution of Property on Hand.
Petitioner proposes to distribute the property on hand to (check applicable box):
5
( ) The personal representative, (_______________), of the deceased decedent’s
(Name)
estate.
6
( ) The successors in interest as follows, because the deceased conservatee’s
7
8
estate subject to probate administrator does not exceed $100,000.
(Name)
(Address)
(Identify item, amount, or percent)
9
10
11
12
13
14
15
16
17
18
( ) Other (state proposed distribution & basis):
(Name)
(Address)
(Identify item, amount, or percent)
19
20
21
22
23
24
25
26
27
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-7Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
1
2
18. Conservator Fees and Costs.
3
Petitioner requests fees as follows:
4
( ) Fees are waived or ( ) Not requested at this time.
5
( ) Fees are requested in the amount of $ ____________ Itemization of services
6
set forth by date, time spent, & hourly rate are set forth in Exhibit “4”. (Note: Exhibit “4”
7
must include a statement of facts which must (1) show the nature and difficulty of tasks
8
performed; (2) show the results achieved; (3) show the benefit of the services to the
9
estate; (4) specify the amount requested for each category of service performed; (5)
10
state the hourly rate of each person who performed services and the hours spent by
11
each of them; (6) describe the services rendered in sufficient detail to demonstrate the
12
productivity of the time spent.
13
Petitioner requests:
14
( ) No Conservator Costs/Expenses
15
( ) Conservator Costs/Expenses advanced in the sum of $ ____________ be
16
reimbursed. Itemization by date, amount, and purpose is set forth in Exhibit “4”.
17
18
19
20
21
22
23
24
25
26
27
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-8Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
1
19. Attorney Fees and Costs. (Note: Attorney must attach a separate verification in
2
support of fees being requested)
3
Petitioner requests attorney fees be approved as follows:
4
( ) Fees are waived or ( ) Not requested at this time.
5
( ) Fees are requested in the amount of $ ___________. Itemization of services
6
set forth by date, time spent, & hourly rate are set forth in Exhibit “5”. (Note: Exhibit “5”
7
must include a statement of facts which must (1) show the nature and difficulty of tasks
8
performed; (2) show the results achieved; (3) show the benefit of the services to the
9
estate; (4) specify the amount requested for each category of service performed; (5)
10
state the hourly rate of each person who performed services and the hours spent by
11
each of them; (6) describe the services rendered in sufficient detail to demonstrate the
12
productivity of the time spent.
13
If the attorney fees requested include a paralegal acting under the direction and
14
supervision of an attorney, then set forth in Exhibit 4 the following information:
15
(1) Describe the qualifications of the paralegal (including education, certification,
16
continuing education, and experience); (2) state the hours spent by the paralegal and
17
the hourly rate requested for the paralegal’s services; (3) describe the services
18
performed by the paralegal; (4) state why it was appropriate to use the paralegal’s
19
services in the particular case; (5) demonstrate that the total amount requested for the
20
extraordinary services of the attorney and the paralegal does not exceed the amount
21
appropriate if the attorney had performed the services without the paralegal’s
22
assistance.
23
Petitioner requests:
24
( ) No Attorney Costs/Expenses
25
( ) Attorney Costs/Expenses advanced in the sum of $ ____________ be
26
reimbursed. Itemization by date, amount, and purpose is set forth in Exhibit “5”.
27
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-9Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
1
20. Compensation Paid from Conservatorship Estate to the Conservator or Attorney
2
for Conservator without prior court order (Check applicable box):
3
( ) Conservator compensation ( ) was ( ) was not paid.
4
( ) Attorney fees ( ) were ( ) were not paid.
5
If compensation or fees were paid, state:
Date
6
Amount
To Whom Paid
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-10Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
1
21. Other (Add any additional information or actions by the conservator to be included
2
in the report for which court approval is requested:
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-11Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
1
WHEREFORE, petitioner requests that:
2
1. The within final report (on waiver of account) be settled, allowed, and approved;
3
2. All acts and transactions as set forth in the final report be approved;
4
3. The conservatorship be terminated.
5
4. Petitioner be authorized and directed to pay from the conservatorship estate to:
6
( ) petitioner the sum of $ ________ as compensation for conservator services
7
8
9
10
11
12
13
14
15
16
17
rendered;
( ) petitioner costs advanced in the sum of $____________ during the period of this
account;
( ) attorney ______________ the sum of $ ________ as compensation for
(Name)
legal services rendered;
( ) attorney ______________ costs advanced in the sum of $____________ during
(Name)
account.
5. After payment of all services ordered the above petitioner be authorized and directed
to distribute the assets on hand as set forth in paragraph 17 of the petition.
6. Other (include additional requests not included above):
18
19
20
21
22
7. Petitioner be discharged as conservator upon application to the court after filing
receipts of distribution.
23
8. For other orders as the court may deem proper.
24
DATED:
25
__________________________________________
Signature
26
27
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-12Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
1
2
VERIFICATION
3
4
5
I, ___________________ declare:
(Petitioner Name)
6
I am the petitioner herein. I have read the foregoing report, and petition and the
7
accompanying exhibits and schedules and know the contents and the same is true of my own
8
knowledge except as to those matters which are therein stated upon my information and belief,
9
and, as to those matters, I believe it to be true.
10
11
I declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct and that this verification was executed on ________, at
(Date)
12
13
Sacramento, California.
14
________________________
15
(Signature)
16
17
18
19
20
21
22
23
24
25
26
27
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-13Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
EXHIBIT “3”
1
PROPERTY ON HAND
2
Current Fair
3
4
Market Value
*Carry Value
1. Bank/Credit Union Accounts
xxxxxxxx
5
(such as checking, savings, money
xxxxxxxx
6
markets, certificate of deposit) (state
xxxxxxxx
7
name of financial institution, account
xxxxxxxx
8
number, & amount of hand at end date
xxxxxxxx
9
of account period)
xxxxxxxx
10
11
12
13
14
15
16
17
2. Real Property
( ) None
( ) Listed below (state common street address,
18
legal description, how title is held, and interest held
19
by the conservatee)
20
21
22
23
24
25
26
27
*(value stated from last acct or if no acct from Inventory & Appraisal)
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-14Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
EXHIBIT “3”
1
PROPERTY ON HAND
2
*Carry Value
3
4
Current Fair
Market Value
3. Stocks & Bonds: (List name of stock or identify the bond,
5
# of shares, and value at end date of
6
account)
7
8
9
10
11
12
13
14
15
4. Automobile (state year, make, and model)
16
17
18
19
20
21
5. Furniture & Personal Effects:
22
23
24
25
26
27
*(value stated from last acct or if no acct from Inventory & Appraisal)
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-15Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
EXHIBIT “3”
1
PROPERTY ON HAND
2
Current Fair
*Carry Value
3
4
Market Value
Other:
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
26
$__________
$__________
27
*(value stated from last acct or if no acct from Inventory & Appraisal)
28
OPTIONAL
PR-E-LP-029 (1.1.07)
-16Final Report on Waiver of Account of Conservator
LOCAL RULE 15.84
American LegalNet, Inc.
www.FormsWorkflow.com
