VN196 ATTORNEY OF PARTY WITHOUT ATTORNEY (Name and Address) FOR COURT USE ONLY Telephone Number E-MAIL ADDRESS ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF VENTURA 800 SOUTH VICTORIA AVE. VENTURA, CA 93009 3855 – F ALAMO ST. SIMI VALLEY, CA 93063-2110 In the Matter of the Conservatorship of CASE NUMBER: CONSERVATORSHIP GENERAL PLAN STATUS REPORT Ventura Court Local Rule 10.02(1) and (J) Hearing Date: Time: Courtroom: Filing Date of Petition: (Your Name) ____________________________________, the conservator of the Person Estate of (Name of Conservatee) _________________________________________________ submits the Conservator’s General Plan Status Report, pursuant to Ventura County Local Court Rule 10.02(I) and (J). 1. Conservatee’s name: ________________________________________________________________ Address: _________________________________________________________________________ Date of birth: __________________ Telephone Number: ___________________________________ 2. Type of residence: own home/apartment skilled nursing home board and care home Conservator’s home/apartment hospital other____________________________________ 3. Description of current level of care: ____________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 4. Physical and mental condition of the conservatee: _________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ 5. Frequency of visits to the conservatee by the conservator ____________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 6. Involvement of family and/or friends of the conservatee: ____________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 7. Estimated annual conservator’s fees: ___________________________________ 8. Estimated annual attorney’s fees: ______________________________________ VN196 New 1/08 CONSERVATORSHIP GENERAL PLAN/STATUS REPORT Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com In the Matter of the Conservatorship of: 9. Case Number: Estimated annual cost of personal care: _________________________________________________________ 10. Anticipated changes in the Conservatee’s residence, level of care, physical and mental condition: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 11. Unusual circumstances related to the conservatee or the Conservatorship estate: __________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Dated: _______________________ ____________________________________________ Signature of Conservator Dated: _______________________ ____________________________________________ Signature of Conservator VERIFICATION I/We declare that: I/We are the Conservator of the Person Estate of ___________________________ _________________________. I/We have read the above Conservatorship General Plan Status Report and know its contents. It is true of my/our own personal knowledge, except as to the matters I/we are informed about, and based on that information; believe those matters to be true. I/We declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dated: _______________________ ___________________________________ Print Name of Conservator ____________________________________________ Signature of Conservator Dated: _______________________ ___________________________________ Print Name of Conservator VN196 New 1/08 ____________________________________________ Signature of Conservator CONSERVATORHIP GENERAL PLAN/STATUS REPORT Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com