San Mateo — Conservatee's Information and List of Relatives

Source: https://sanmateo.courts.ca.gov/system/files/local-forms/l-pr-1ncac.pdf

CONFIDENTIAL (DO NOT ATTACH TO PETITION) ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address) FOR COURT USE ONLY

TELEPHONE NO: FAX NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN MATEO STREET ADDRESS: HALL OF JUSTICE AND RECORDS MAILING ADDRESS: 400 COUNTY CENTER CITY AND ZIP CODE: REDWOOD CITY CA 94063-1662 BRANCH NAME: Southern Branch CONSERVATORSHIP OF (Name): PROPOSED CONSERVATEE CONSERVATEE’S INFORMATION AND LIST OF RELATIVES CASE NUMBER: ** CONFIDENTIAL ** (Probate Conservatorship) Conservatorship of Person Estate Limited Conservatorship

HEARING DATE:
Initial Accounting/Review Change of Address

Date Conservator Appointed: DEPT: TIME:

Effective Date of Move:

Note: Indicate any special issues relating to a conservatorship investigation (Examples: language spoken, personal safety, communication issues, etc.):

(Proposed) Conservatee:

Name:

Address: Zip:

Phone No.: Contact Person:

Name of Day Program/School/Work Program: NOTE: If Conservatee is always or frequently at another location between the hours of 8:00 a.m. and 5:00 p.m., Monday through Friday, please identify that location and provide the address, telephone number, and name of a contact person below.

Name: Type of Program:

Address: Zip:

Phone No.: Contact Person:

(Proposed) Conservator:

Name: Relationship:

Address: Zip:

Phone No.: Work: Fax: Cell:

Email:

CONSERVATEE’S INFORMATION & LIST OF RELATIVES - CONFIDENTIAL

Form Adopted for Mandatory Use (Probate Conservatorship) Probate Code, § 1826 Superior Court of California, County of San Mateo Local Rule of Court, Rule 4.81.1 PR-1 [Revised and effective on August 2009]

CONSERVATORSHIP OF (Name): CASE NUMBER:

(Proposed) Co-Conservator:

Name: Relationship:

Address: Zip:

Phone No.: Work: Fax: Cell:

Email:

Attorney for (Proposed) Conservator:

Name/Firm:

Address: Zip:

Phone No.: Fax No.:

Email:

Attorney for (Proposed) Co-Conservator: (if applicable)

Name/Firm:

Address: Zip:

Phone No.: Fax No.:

Email:

Attorney for (Proposed) Conservatee: (if applicable)

Name/Firm:

Address: Zip:

Phone No.: Fax No.:

Email:

(Proposed) Conservatee’s Physician/Practitioner:

Name:

Institution (if applicable):

Address: Zip:

Phone No.:

CONSERVATEE’S INFORMATION & LIST OF RELATIVES - CONFIDENTIAL

Form Adopted for Mandatory Use (Probate Conservatorship) Probate Code, § 1826 Superior Court of California, County of San Mateo Local Rule of Court, Rule 4.81.1 PR-1 [Revised and effective on August 2009]

CONSERVATORSHIP OF (Name): CASE NUMBER:

LIST OF CONSERVATEE’S RELATIVES/FRIENDS

Please list spouse or registered domestic partner, conservatee’s 1 st degree relatives (parents and children) and 2nd degree relatives (brothers, sisters, grandparents & grandchildren). If there is a close friend or neighbor who is involved, please list.

Name: Relationship:

Address: Zip:

Home Phone No.: Work Phone No.:

Email:

Name: Relationship:

Address: Zip:

Home Phone No.: Work Phone No.:

Email:

Name: Relationship:

Address: Zip:

Home Phone No.: Work Phone No.:

Email:

Name: Relationship:

Address: Zip:

Home Phone No.: Work Phone No.:

Email:

Name: Relationship:

Address: Zip:

Home Phone No.: Work Phone No.:

Email:

CONSERVATEE’S INFORMATION & LIST OF RELATIVES - CONFIDENTIAL

Form Adopted for Mandatory Use (Probate Conservatorship) Probate Code, § 1826 Superior Court of California, County of San Mateo Local Rule of Court, Rule 4.81.1 PR-1 [Revised and effective on August 2009]

CONSERVATORSHIP OF (Name): CASE NUMBER:

Name: Relationship:

Address: Zip:

Home Phone No.: Work Phone No.:

Email:

Name: Relationship:

Address: Zip:

Home Phone No.: Work Phone No.:

Email:

Please use Local Court Form PR – 1A if more space is needed to continue list.

Additional pages attached (Form PR-1A) (check box if applicable).

NOTE: This form is to be filed by: 1. The Proposed Conservator with the Petition for Conservatorship. 2. The Conservator when filing a Petition for Accounting. 3. The Conservator upon change of address of the Conservatee and/or Conservator 4. Each Co-Conservator, if there is more than one conservator, unless both co-conservators agree to put their information on one form.

Please mail completed form and one additional copy to: SAN MATEO COUNTY SUPERIOR COURT PROBATE CLERK’S OFFICE 400 COUNTY CENTER, 1 ST FLOOR REDWOOD CITY, CA 94063-1655

CONSERVATEE’S INFORMATION & LIST OF RELATIVES - CONFIDENTIAL

Form Adopted for Mandatory Use (Probate Conservatorship) Probate Code, § 1826 Superior Court of California, County of San Mateo Local Rule of Court, Rule 4.81.1 PR-1 [Revised and effective on August 2009]