Alameda — Conservatorship General Plan Form

Source: https://www.alameda.courts.ca.gov/system/files/forms-and-filings/conservatorship-general-plan-form.pdf

ATTORNEY OF RECORD: TO BE COMPLETED BY THE CONSERVATOR AND FILED THIRTY DAYS PRIOR TO THE GENERAL PLAN HEARING DATE. THE CONSERVATOR SHOULD RETAIN A COPY.

SUPERIOR COURT OF CALIFORNIA

COUNTY OF ALAMEDA

Conservatorship of the ) Probate No. estate of ) ) CONSERVATORSHIP GENERAL PLAN ) ) conservatee) Date: Time: Department:

, the conservator(s) of the estate of

hereby submits the conservator's General

Plan in compliance with Local Court Rules.

1. Conservatee Information: Name: Date of Birth: Social Security Number:

2. Address:

   Telephone:

3. Conservatee's residence:

own home/apartment conservator's home/apartment
skilled nursing home board and care home
hospital (medical/psychiatric) other (specify)

How long has the Conservatee been in the present residence?

Do you anticipate making any changes in the Conservatee's residence in the next year? No Yes (explain)

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4. How often do you expect to visit the Conservatee?

5. Do you plan to request conservator fees at the end of the first year? No Yes (anticipated amount of request) $

6. Conservatee's Estimated Monthly Income

Social Security/SSI $ Dividends $

Pension (source) $ Rental $

Veteran's benefits $ Interest $

Other (specify) $

Total Estimated Monthly Income $

7. Conservatee's Estimated Monthly Expenses

LIVING EXPENSES Rent/Mortgage $ Utilities $ Nursing/Care Home $ In-home care $ Food $ Clothing $ Medical/Dental $ Medications $ Transportation $ Entertainment $ Other (specify) $ Total Estimated Monthly Expenses $

8. Other Expenses

TAXES Current Estimated Amount Income Tax Yes No $ Property Yes No $ Payroll Yes No $

INSURANCE Company Coverage Amount Estimated premium Homeowner ________ $ $ Renters $ $ Automobile $ $ 2

Worker's Comp $ $ Health $ $ Life $ $

Does the Conservatee receive Medi-Cal benefits? No Yes $ share of cost

9. Do you expect to sell any of the Conservatee’s real or personal property in the next year? No Yes

   If yes, explain why:

10. Does the conservatee own a home in which he/she does not live? No

    Yes. Is it rented? Amount of rent: $

    If not rented explain why:

11. If the conservatee’s monthly expenses are greater than monthly income, explain how the shortfall will be met:

12. Does the conservatee have a trust or is he/she entitled to receive income from a trust? If so, please provide an attachment with the name of the trust, any court case number for the trust, the name(s)of the trustee(s)and their contact information.

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13. Do you anticipate any unusual activities related to the management of the conservatee's estate during the next year?

    No Yes (explain)

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The undersigned conservator will: a. Inventory all assets in which the conservatee has any interest; b. Render timely, accurate and complete accountings to the court; c. Carry out all mandatory usual and general duties of a conservator; d. Maintain accurate records related to the estate; e. Maintain all estate assets in a separate identifiable manner; f. Maintain estate cash assets in interest-bearing accounts, except as necessary for everyday administration; g. Maintain an adequate surety bond as required by law. h. Refer to the "Conservator's Handbook".

I declare under penalty of perjury under the laws of the State of California

that the foregoing is true and correct, and that I have retained a copy of this case plan for my records.

Dated:

Signature of Conservator(s)

Type or print name(s)

Rev: 4/25; Ct. Inv.

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