Choose a location SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA BARBARA STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CONSERVATORSHIP OF: FOR COURT USE ONLY CASE NUMBER: FEE DECLARATION: CONSERVATOR INSTRUCTIONS: This fee declaration may be used for fees requested by conservators of the person and/or estate. If this form is used, the declaration must be filled out completely and attachments should be used where additional space is needed. This form should not be used for guardianships, decedent's estates or trust matters. 1. I am the conservator in this matter. I am related to the conservatee as (specify relationship) . 2. This accounting period begins on requesting fees for services performed during this period. and ends on . I am 3. During the period identified in item 2, the conservatee was living at the following residence or facility (address and name of facility, if any): Telephone number: 4. The residence or facility identified in item 3 is described as: Conservatee's single family home, condominium, or apartment Relative's or friend's single family home, condominium, or apartment Licensed residential care facility Assisted living facility (more than 7 beds) Board and care facility (6 or fewer beds) Acute care hospital Acute psychiatric hospital Intermediate care facility Skilled nursing facility Other: 5. During this accounting period (identified in item 2): a. Number of personal visits to conservatee by conservator: b. Number of hospitalizations or emergency medical treatment: c. Changes in residence Page 1 of 3 Optional Form SC-6030 [Adopted 1/1/2013] FEE DECLARATION: CONSERVATOR CRC 7.702/7.751 http://www.sbcourts.org/ American LegalNet, Inc. www.FormsWorkFlow.com CONSERVATORSHIP OF: CASE NUMBER: 6. Did the conservator retain a bookkeeper or accountant or other person to perform routine estate functions: Yes No If yes, name the bookkeeper or other person, the functions performed and the total sum paid to the person, if paid by the estate (use attachment if necessary): Name Function Amount Paid 7. Did the conservator retain a professional to advise/manage the conservatee's assets: Yes No If yes, please describe the work performed, who performed the work, how that person was compensated and if compensated by the estate, the total sum paid to that person. Continued in Attachment 7 (Continued on next page) Page 2 of 3 Optional Form SC-6030 [Adopted 1/1/2013] FEE DECLARATION: CONSERVATOR CRC 7.702/7.751 American LegalNet, Inc. www.FormsWorkFlow.com CONSERVATORSHIP OF: CASE NUMBER: 8. Summary of Services Provided List services provided by general category, total hours, hourly rate and total fee. For each general category of services, please submit a corresponding attachment that includes the statement of facts required by California Rules of Court rule 7.702. In order to describe the services rendered in sufficient detail to demonstrate the productivity of the time spent, each general category must be supported with details of the hours spent cataloged by date. Common services are included. Please use additional blank spaces to identify any other categories of service not included. Service Supervising and communicating with caregivers Communicating with health providers Visits to conservatee Communicating with conservatee's family and friends Arranging moves Legal and insurance matters Paying conservatee's bills Preparation of accounting petition Total Hours Hourly Rate Total Fee TOTAL: Continued in Attachment 8 Total hours and fees approved by the court during the previous period: Hours: ____________ Fees: $ _________________ Total fees requested during this accounting period: $ ________________. Number of months in this accounting period: _____________ Total average monthly fee requested: $___________ /month. I declare under the laws of the State of California that the foregoing is true and correct. Date: _________________ ________________________________ (Type or print name of conservator) ___________________________________ (Signature of Conservator) Page 3 of 3 Optional Form SC-6030 [Adopted 1/1/2013] FEE DECLARATION: CONSERVATOR CRC 7.702/7.751 American LegalNet, Inc. www.FormsWorkFlow.com