PR-E-L-044 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address) FOR COURT USE ONLY TELEPHONE NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR NAME ATTORNEY FOR (Name): FAX NO. (Optional): 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): CONSERVATEE CASE NUMBER: REQUEST FOR WAIVER OF PROBATE COURT INVESTIGATOR FEE CONSERVATORSHIP CASES ONLY I, ______________________________________________, request a waiver of the investigation fee because: Proposed Conservator/ Conservator 1. Conservatee/Proposed Conservatee receives the following: (check all that apply) Food Stamps SSI SSP IHSS (In-Home Supportive Services) CAPI (Cash assistance for Program for Aged, Blind and Disabled CalWORKS or Tribal TANF (Tribal Temporary Assistance for Needy Families) 2. The Conservatee's or Proposed Conservatee's monthly income (before deductions for taxes) is less than $1128.13. If married, the Conservatee's or Proposed Conservatee's monthly income (before deductions for taxes) is less than $1517.71. 3. I declare under penalty of perjury under the laws of the State of California that the information I have provided on this form is true and correct. CONSERVATOR OR PROPOSED CONSERVATOR SIGNATURE DATE CONSERVATOR OR PROPOSED CONSERVATOR NAME (PRINTED) PRIMARY PHONE NUMBER PR-E-LP-044 MANDATORY Request For Waiver of Probate Court Investigator Fee Conservatorship Case Only www.saccourt.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com