ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME, STATE BAR NUMBER AND ADDRESS) FOR COURT USE ONLY TELEPHONE NUMBER: FAX NO. (Optional): EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN LUIS OBISPO STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: 1035 Palm Street, Room 385 Same as above San Luis Obispo, CA 93408 San Luis Obispo Division LPS CONSERVATORSHIP OF: CASE NUMBER: Date: Time: Department PETITION FOR REAPPOINTMENT OF LPS CONSERVATOR PETITIONER (name): __________________________________________ states: 1. Petitioner was appointed conservator of the person of the conservatee (name): __________________________________________________. 2. Petitioner qualified, and Letters of Conservatorship were duly issued on or about (date): ____________________________________________. 3. Petitioner is now, and since that date has been, the duly appointed, qualified, and acting LPS conservator of the person of the conservatee. 4. The conservatee is presently confined at: _________________________________. It is the professional opinion of: ____________________________________, M.D., and ________________________________________, M.D., as set forth in their declaration dated: _____________________________________ and filed herewith (incorporated by reference), that the LPS conservatee is still gravely disabled as a result of a mental disorder or impairment by chronic alcoholism and is unwilling to accept or incapable of accepting treatment voluntarily. Page 1 of 4 Form Adopted for Optional Use San Luis Obispo Superior Court Local Form PR009 Rev. 1/1/15 PETITION FOR REAPPOINTMENT OF LPS CONSERVATOR American LegalNet, Inc. www.FormsWorkFlow.com LPS CONSERVATORSHIP OF: CASE NUMBER 5. Petitioner is informed and believes and on that information and belief alleges that the conservatee is still a gravely disabled person as defined in Welfare and Institutions Code §5008(h) as a result of a mental disorder or impairment by chronic alcoholism, is unwilling to accept or incapable of accepting treatment voluntarily, and is in need and does require a conservator of his or her person. 6. It is in the best interests of the conservatee and necessary that the conservator have the following powers: a. The power to place, for the purpose of involuntary care and treatment, the conservatee in a medical, psychiatric, nursing or other state-licensed facility, or a state hospital, county hospital, hospital operated by the Regents of the University of California, United States Government Hospital, or other nonmedical facility approved by the State Department of Mental Health or an agency accredited by the State Department of Mental Health; or, in cases of chronic alcoholism, in a county alcoholic treatment center, as provided in Welfare and Institutions Code §5358. The power to require the conservatee to receive treatment related specifically to remedying or preventing the recurrence of the Conservatee's being gravely disabled. b. c. (Mark if applicable) The power to require the conservatee to receive other medical treatment unrelated to remedying or preventing the recurrence of the Conservatee's being gravely disabled which is necessary for the treatment of an existing or continuing medical condition, namely (specify medical condition and treatment):___________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 7. It is necessary and in the best interests of the conservatee that the conservatee not be permitted to (Mark all that are applicable): a. b. c. d. Possess a license to operate a motor vehicle; To possess or carry firearms; To enter into contracts; To vote. PETITION FOR REAPPOINTMENT OF LPS CONSERVATOR Page 2 of 4 Form Adopted for Optional Use San Luis Obispo Superior Court Local Form PR009 Rev. 1/1/15 American LegalNet, Inc. www.FormsWorkFlow.com LPS CONSERVATORSHIP OF: CASE NUMBER 8. WHEREFORE, Petitioner prays that: a. b. A LPS conservator of the person be reappointed for the conservatee. The LPS conservator of the person be given the power to place, for the purpose of involuntary care and treatment, the conservatee in a medical, psychiatric, nursing, or other state-licensed facility, or a state hospital, county hospital, hospital operated by the Regents of the University of California, United States Government hospital, or other nonmedical facility approved by the State Department of Mental Health; or, in a case of chronic alcoholism, in a county alcoholic treatment center pursuant to Welfare and Institutions Code §5358. The LSP conservator of the person be given the powers to require the conservatee to receive treatment related specifically to remedying or preventing the recurrence of the Conservatee's being gravely disabled. c. d. (Mark if applicable) That the LPS conservator of the person be given the power to require the conservatee to receive other medical treatment unrelated to remedying or preventing the recurrence of the Conservatee's being gravely disabled, which is necessary for the treatment of an existing or continuing medical condition, namely (specify medical condition and treatment):______________________________________________________ _______________________________________________________________ _______________________________________________________________ ______________________________________________________________. The conservatee not be allowed to (Mark all that are applicable): i. ii. iii. iv. e. Possess a license to operate a motor vehicle; To possess or carry firearms; To enter into contracts; To vote. f. Other relief be granted as the court deems proper. Date: _____________________ _________________________________ (Print Name) Form Adopted for Optional Use San Luis Obispo Superior Court Local Form PR009 Rev. 1/1/15 _______________________________ (Signature of proposed conservator) Page 3 of 4 PETITION FOR REAPPOINTMENT OF LPS CONSERVATOR American LegalNet, Inc. www.FormsWorkFlow.com LPS CONSERVATORSHIP OF: CASE NUMBER VERIFICATION I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:_____________________ ______________________________________ (Sig