PR - 24 ATTORNEY OR CONSERVATOR (Name, state bar number, and address) FOR COURT USE ONLY TELEPHONE NO: E-MAIL ADDRESS (Optional): CONSERVATOR FOR (Name): STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: 400 County Center Redwood City, CA 94063 Southern Branch FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN MATEO CONSERVATORSHIP OF (Name): CONSERVATEE CONSERVATOR(S) OF THE ESTATE DECLARATION IN LIEU OF ACCOUNTING (Pursuant to Probate Code � 2628 and Local Rule of Court, Rule 4.81.16) CASE NUMBER: I (We) am/are the duly appointed Conservator(s) of the Estate of the above named Conservatee and declare as follows for the review date of: 1. The estate, at the beginning and end of the review period for which an account is otherwise required (pursuant per �2628 of the Probate Code) consisted of property, exclusive of the residence of the conservatee, with a total net value of less than fifteen thousand dollars ($15,000.00); The income of the estate for each month of the accounting period, exclusive of public benefits payments, was less than two thousand dollars ($2,000.00); All income of the estate during the accounting period, if not retained, was spent for the benefit of the conservatee. 2. 3. I (We) certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dated: at ,California Conservator Conservator CONSERVATOR(S) OF THE ESTATE DECLARATION IN LIEU OF ACCOUNTING Form Approved for Optional Use Superior Court of California, County of San Mateo PR- 24 [Revised, March, 2008] (Probate Conservatorship) Probate Code, � 2628, Local Rule, Rule 4.81.16 American LegalNet, Inc. www.FormsWorkflow.com