San Luis Obispo — PR009

Source: https://www.slo.courts.ca.gov/documents/san-luis-obispo/PR_009_SLO.pdf

ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME, STATE BAR NUMBER AND ADDRESS) FOR COURT USE ONLY

TELEPHONE NUMBER: FAX NO. (Optional):

EMAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN LUIS OBISPO

STREET ADDRESS: 1035 Palm Street, Room 385
MAILING ADDRESS: Same as above
CITY AND ZIP CODE: San Luis Obispo, CA 93408
BRANCH NAME: San Luis Obispo Division

LPS CONSERVATORSHIP OF: CASE NUMBER:

Date: Time: Department

PETITION FOR REAPPOINTMENT OF LPS CONSERVATOR

PETITIONER (name): __________________________________________ states:

1. Petitioner was appointed conservator of the person of the conservatee (name): __________________________________________________.

2. Petitioner qualified, and Letters of Conservatorship were duly issued on or about (date): ____________________________________________.

3. Petitioner is now, and since that date has been, the duly appointed, qualified, and acting LPS conservator of the person of the conservatee.

4. The conservatee is presently confined at: _________________________________. It is the professional opinion of: ____________________________________, M.D.,

and ________________________________________, M.D., as set forth in their declaration dated: _____________________________________ and filed herewith (incorporated by reference), that the LPS conservatee is still gravely disabled as a result of a mental disorder or impairment by chronic alcoholism and is unwilling to accept or incapable of accepting treatment voluntarily.

Form Adopted for Optional Use PETITION FOR REAPPOINTMENT OF LPSSan Luis Obispo Superior Court Local Form PR009 CONSERVATOR Rev. 1/1/15

LPS CONSERVATORSHIP OF: CASE NUMBER

5. Petitioner is informed and believes and on that information and belief alleges that the
conservatee is still a gravely disabled person as defined in Welfare and Institutions
Code §5008(h) as a result of a mental disorder or impairment by chronic alcoholism,
is unwilling to accept or incapable of accepting treatment voluntarily, and is in need
and does require a conservator of his or her person.

6. It is in the best interests of the conservatee and necessary that the conservator have
the following powers:

a. The power to place, for the purpose of involuntary care and treatment, the
conservatee in a medical, psychiatric, nursing or other state-licensed facility, or
a state hospital, county hospital, hospital operated by the Regents of the
University of California, United States Government Hospital, or other non -
medical facility approved by the State Department of Mental Health or an
agency accredited by the State Department of Mental Health; or, in cases of
chronic alcoholism, in a county alcoholic treatment center, as provided in
Welfare and Institutions Code §5358.

b. The power to require the conservatee to receive treatment related specifically
to remedying or preventing the recurrence of the Conservatee’s being gravely
disabled.
c. □ (Mark if applicable) The power to require the conservatee to receive other
medical treatment unrelated to remedying or preventing the recurrence of the
Conservatee’s being gravely disabled which is necessary for the treatment of
an existing or continuing medical condition, namely (specify medical condition
and treatment):___________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

7. It is necessary and in the best interests of the conservatee that the conservatee not
be permitted to (Mark all that are applicable):
a. □ Possess a license to operate a motor vehicle;
b. □ To possess or carry firearms;
c. □ To enter into contracts;
d. □ To vote.

Form Adopted for Optional Use PETITION FOR REAPPOINTMENT OF LPSSan Luis Obispo Superior Court Local Form PR009 CONSERVATOR Rev. 1/1/15

LPS CONSERVATORSHIP OF: CASE NUMBER

8. WHEREFORE, Petitioner prays that:

a. A LPS conservator of the person be reappointed for the conservatee.

b. The LPS conservator of the person be given the power to place, for the
purpose of involuntary care and treatment, the conservatee in a medical,
psychiatric, nursing, or other state-licensed facility, or a state hospital, county
hospital, hospital operated by the Regents of the University of California, United
States Government hospital, or other nonmedical facility approved by the State
Department of Mental Health; or, in a case of chronic alcoholism, in a county
alcoholic treatment center pursuant to Welfare and Institutions Code §5358.

c. The LSP conservator of the person be given the powers to require the
conservatee to receive treatment related specifically to remedying or preventing
the recurrence of the Conservatee’s being gravely disabled.
d. □ (Mark if applicable) That the LPS conservator of the person be given the
power to require the conservatee to receive other medical treatment unrelated
to remedying or preventing the recurrence of the Conservatee’s being gravely
disabled, which is necessary for the treatment of an existing or continuing
medical condition, namely (specify medical condition and
treatment):______________________________________________________
_______________________________________________________________
_______________________________________________________________
______________________________________________________________.

e. The conservatee not be allowed to (Mark all that are applicable):
i. □ Possess a license to operate a motor vehicle;
ii. □ To possess or carry firearms;
iii. □ To enter into contracts;
iv. □ To vote.

f. Other relief be granted as the court deems proper.

Date: _____________________

_________________________________ _______________________________
(Print Name) (Signature of proposed conservator)

Form Adopted for Optional Use PETITION FOR REAPPOINTMENT OF LPSSan Luis Obispo Superior Court Local Form PR009 CONSERVATOR Rev. 1/1/15

LPS CONSERVATORSHIP OF: CASE NUMBER

VERIFICATION

I declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct.

Date:_____________________ ______________________________________
(Signature of proposed conservator)

Form Adopted for Optional Use PETITION FOR REAPPOINTMENT OF LPSSan Luis Obispo Superior Court Local Form PR009 CONSERVATOR Rev. 1/1/15