7020 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO.(Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SOLANO STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: 600 Union Avenue P.O. Caller 5000 Fairfield, CA 94533 321 Tuolumne Street 321 Tuolumne Street Vallejo, CA 94590 IN RE THE CONSERVATORSHIP OF: CASE NUMBER: VERIFICATION OF VIEWING OF CONSERVATORSHIP VIDEO Instructions Before you may be appointed as a conservator, you must watch a video called With Heart: Understanding Conservatorships. This video discusses the duties and responsibilities of a conservator. The video is available to you in two ways: · You may make an appointment with the Court Investigators Office to view it at the courthouse. · You may view the video online at http://www.saclaw.lib.ca.us/pages/conservatorship-video.aspx Once you have watched the video, you must fill out, sign, and file this form with the court. I have petitioned the court to be appointed the conservator of the person and/or estate of (name):_____________________________________________________________________. I viewed the court's videotape presentation on the duties and responsibilities of the conservator on (date) ___________________________________ at the following location: Court Investigators Office On-line viewing located at http://www.saclaw.lib.ca.us/pages/conservatorship-video.aspx I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. (Type or print name) (Signature of Declarant) VERIFICATION RE: VIEWING OF CONSERVATORSHIP VIDEO Adopted for Mandatory Use Solano County Local Form no. 7020 Eff. 07/11 American LegalNet, Inc. www.FormsWorkFlow.com SCLR 15.52 Page 1 of 1