NONDOMICILIARY REPORT/ CONSERVATORSHIP PC-371B NEW 10/07 STATE OF CONNECTICUT RECORDED(CONFIDENTIAL VOLUME): COURT OF PROBATE [Type or print in black ink.] [Use back of form or additional sheets if more space is required.] TO: COURT OF PROBATE, DISTRICT OF DISTRICT NO. IN THE MATTER OF [Name, address, zip code, and date of birth] PRESENT ADDRESS OF CONSERVED PERSON HEREINAFTER REFERRED TO AS THE "CONSERVED PERSON" ATTORNEY FOR CONSERVED PERSON [Name, address, zip code, and telephone number] CONSERVATOR OF THE PERSON [Name, address, zip code, and telephone number] Reporting period covered by this report --- FROM: Is the conserved person now domiciled in Connecticut? TO: YES NO [If this box is checked, all sections that follow must be completed.] Describe the efforts made to provide notice concerning the conserved person to individuals and applicable agencies in the state of domicile during this reporting period. The conserved person has been provided an opportunity and the financial means to return to his or her place of domicile within his or her resources and has declined to return. [Explain.] Reasonable but unsuccessful efforts have been made to return the conserved person to his or her place of domicile. [Explain.] This section is to be completed for reviews of conservatorship pursuant to C.G.S. §45a-648. continued modified terminated. Give reasons for your answer below. In my opinion, the conservatorship should be Dated at: ,Connecticut, on [Month, Day, Year] ................................................................................................. Conservator: Attorney for conserved person: NONDOMICILIARY REPORT/CONSERVATORSHIP PC-371B American LegalNet, Inc. www.FormsWorkFlow.com