ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address) TELEPHONE AND FAX NOS: FOR COURT USE ONLY ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA , COUNTY OF SACRAMENTO STREET ADDRESS: 3341 POWER INN ROAD, ROOM 214 MAILING ADDRESS: CITY AND ZIP CODE: SACRAMENTO, CA 95826 BRANCH NAME: WM. R. RIDGEWAY FAMILY RELATIONS COURTHOUSE CONSERVATORSHIP OF (Name): ORDER PRESCRIBING NOTICE AND APPOINTMENT OF COUNSEL CASE NUMBER: A petition to authorize the conservator to consent to medical treatment and/or placement of the conservatee/proposed conservatee for dementia pursuant to Probate Code Section 2356.5, having been presented for filing and good cause appearing, IT IS HEREBY ORDERED as follows: 1.A) (Name) (Address) (State Bar #) (City) (Zip Code) ( ) (Telephone) is appointed as counsel for the conservatee/proposed conservatee as it relates to this Petition (with reasonable compensation to be paid from funds belonging to the conservatee, if any; payment by the County shall be according to the Court's fee schedule). B) Counsel ______________________________ was previously appointed on behalf of the conservatee. 2. Notice of the Hearing and a copy of the petition shall be served by mail 15 days prior to the hearing on court appointed counsel, the conservatee/proposed conservatee, persons required to be named in a petition for the appointment of a conservator, and persons required to be given notice under Chapter 3 (commencing with section 1460) of Part 1 of the Probate Code. Date: JUDGE OF THE SUPERIOR COURT Order Prescribing Notice and Appointment of Counsel (Probate) PR-E-LP-019 (REV.01.01.05) LOCAL RULE 15.103 American LegalNet, Inc. www.USCourtForms.com