CONFIDENTIAL (DO NOT ATTACH TO PETITION) ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address) FOR COURT USE ONLY TELEPHONE NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN MATEO HALL OF JUSTICE AND RECORDS 400 COUNTY CENTER REDWOOD CITY CA 94063-1662 Southern Branch PROPOSED CONSERVATEE CONSERVATORSHIP OF (Name): CONSERVATEE'S INFORMATION AND LIST OF RELATIVES ** CONFIDENTIAL ** (Probate Conservatorship) Conservatorship of Person Estate Limited Conservatorship HEARING DATE: CASE NUMBER: Initial Accounting/Review Change of Address DEPT: TIME: Date Conservator Appointed: Effective Date of Move: Note: Indicate any special issues relating to a conservatorship investigation (Examples: language spoken, personal safety, communication issues, etc.): (Proposed) Conservatee: Name: Address: Phone No.: Contact Person: Zip: Name of Day Program/School/Work Program: NOTE: If Conservatee is always or frequently at another location between the hours of 8:00 a.m. and 5:00 p.m., Monday through Friday, please identify that location and provide the address, telephone number, and name of a contact person below. Name: Address: Phone No.: Type of Program: Zip: Contact Person: (Proposed) Conservator: Name: Address: Phone No.: Email: Page 1 of 4 Relationship: Zip: Work: Fax: Cell: Form Adopted for Mandatory Use Superior Court of California, County of San Mateo PR-1 [Revised and effective on August 2009] CONSERVATEE'S INFORMATION & LIST OF RELATIVES - CONFIDENTIAL (Probate Conservatorship) Probate Code, § 1826 Local Rule of Court, Rule 4.81.1 American LegalNet, Inc. www.FormsWorkFlow.com CONSERVATORSHIP OF (Name): CASE NUMBER: (Proposed) Co-Conservator: Name: Address: Phone No.: Work: Fax: Cell: Relationship: Zip: Email: Attorney for (Proposed) Conservator: Name/Firm: Address: Phone No.: Email: Attorney for (Proposed) Co-Conservator: (if applicable) Name/Firm: Address: Phone No.: Email: Attorney for (Proposed) Conservatee: (if applicable) Name/Firm: Address: Phone No.: Email: (Proposed) Conservatee's Physician/Practitioner: Name: Institution (if applicable): Address: Phone No.: Zip: Fax No.: Zip: Fax No.: Zip: Fax No.: Zip: Page 2 of 4 Form Adopted for Mandatory Use Superior Court of California, County of San Mateo PR-1 [Revised and effective on August 2009] CONSERVATEE'S INFORMATION & LIST OF RELATIVES - CONFIDENTIAL (Probate Conservatorship) Probate Code, § 1826 Local Rule of Court, Rule 4.81.1 American LegalNet, Inc. www.FormsWorkFlow.com CONSERVATORSHIP OF (Name): CASE NUMBER: LIST OF CONSERVATEE'S RELATIVES/FRIENDS Please list spouse or registered domestic partner, conservatee's 1st degree relatives (parents and children) and 2nd degree relatives (brothers, sisters, grandparents & grandchildren). If there is a close friend or neighbor who is involved, please list. Name: Address: Home Phone No.: Email: Relationship: Zip: Work Phone No.: Name: Address: Home Phone No.: Email: Relationship: Zip: Work Phone No.: Name: Address: Home Phone No.: Email: Relationship: Zip: Work Phone No.: Name: Address: Home Phone No.: Email: Relationship: Zip: Work Phone No.: Name: Address: Home Phone No.: Email: Page 3 of 4 Relationship: Zip: Work Phone No.: Form Adopted for Mandatory Use Superior Court of California, County of San Mateo PR-1 [Revised and effective on August 2009] CONSERVATEE'S INFORMATION & LIST OF RELATIVES - CONFIDENTIAL (Probate Conservatorship) Probate Code, § 1826 Local Rule of Court, Rule 4.81.1 American LegalNet, Inc. www.FormsWorkFlow.com CONSERVATORSHIP OF (Name): CASE NUMBER: Name: Address: Home Phone No.: Email: Relationship: Zip: Work Phone No.: Name: Address: Home Phone No.: Email: Relationship: Zip: Work Phone No.: Please use Local Court Form PR ­ 1A if more space is needed to continue list. Additional pages attached (Form PR-1A) (check box if applicable). NOTE: This form is to be filed by: 1. The Proposed Conservator with the Petition for Conservatorship. 2. The Conservator when filing a Petition for Accounting. 3. The Conservator upon change of address of the Conservatee and/or Conservator 4. Each Co-Conservator, if there is more than one conservator, unless both co-conservators agree to put their information on one form. Please mail completed form and one additional copy to: SAN MATEO COUNTY SUPERIOR COURT PROBATE CLERK'S OFFICE 400 COUNTY CENTER, 1ST FLOOR REDWOOD CITY, CA 94063-1655 Page 4 of 4 Form Adopted for Mandatory Use Superior Court of California, County of San Mateo PR-1 [Revised and effective on August 2009] CONSERVATEE'S INFORMATION & LIST OF RELATIVES - CONFIDENTIAL (Probate Conservatorship) Probate Code, § 1826 Local Rule of Court, Rule 4.81.1 American LegalNet, Inc. www.FormsWorkFlow.com