I-H SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION IN RE: Intervention Proceeding No. An Adult PETITION OF CONSERVATOR FOR INSTRUCTIONS REGARDING STATEMENT OF CLAIM I . A statement of claim was filed on by who seeks payment of for the following described consideration: 2. Conservator seeks instructions of the court regarding said claim: 3. The reasons such instructions are sought are: Attorney for Conservator Conservator Form PD- 1877A/Sep. 89 2002 © American LegalNet, Inc. CERTIFICATE OF SERVICE I hereby certify that on the , a copy of the foregoing day of was served by first class mail, postage prepaid, upon the following parties to the above captioned case and persons granted permission to SCR-PD 303 and persons who requested notice pursuant to SCR-PD 304. Signature Form PD -1877B/Sep. 89 2002 © American LegalNet, Inc.