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