Santa Clara — PB-4062*

Source: https://santaclara.courts.ca.gov/system/files/forms/pb-4062_rem.pdf

ATTACHMENT PB-4062 ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS) TELEPHONE NUMBER: FOR COURT USE ONLY

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ATTORNEY FOR (Name): Reset Form button at the end SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA of this form when finished. STREET ADDRESS: 191 North First Street

MAILING ADDRESS: 191 North First Street

CITY AND ZIP CODE: San José, California 95113

BRANCH NAME: Downtown Courthouse - Probate Division

CONSERVATORSHIP PERSON ESTATE OF

(Name):: _______________________________________________________________

PROPOSED CONSERVATEE

CONSERVATORSHIP STIPULATION CASE NUMBER:
AND PROPOSED ORDER
DEPARTMENT:
Modification

1. a. Not based on a hearing

   b. Today’s Hearing (date)

2. Judge:

3. Parties/Attorneys:

   a. Petitioner present Petitioner’s attorney present:

   b. Proposed Conservator present Proposed Conservator’s attorney present:

   c. Proposed Conservatee present Proposed Conservatee’s attorney present:

   d. Other party present Other party’s attorney present:

   e. Other party present Other party’s attorney present:

4. The parties agree/stipulate that the provisions listed on the attachment(s) to this form become Court orders.

5. Number of attached pages:

6. Previous Orders that are not inconsistent with the orders herein shall remain in full force and effect.

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ATTACHMENT PB-4062 PETITIONER: CASE NUMBER:

RESPONDENT:

7. We have read this entire Stipulation and Order, including all Attachments. We understand the terms of the Stipulation fully, and ask that the Court make our stipulation the court orders. We give up the right to all further notice of this order.

   Date: Petitioner

   Date: Attorney for Petitioner

   Date: Proposed Conservator

   Date: Attorney for Proposed Conservator

   Date: Attorney for Proposed Conservatee

   Date: Other party:

   Date: Other party:

8. Interpreter Witness Declaration

   Interpreter: The Petitioner Proposed Conservator Proposed Conservatee Other party

   is unable to read or understand this Stipulation and Order and its attachments because:

   a. his/her primary language is (specify):
   b. other (specify):

9. I certify under penalty of perjury under the laws of the State of California that I have, to the best of my ability, read

or translated for the Petitioner Proposed Conservator Proposed Conservatee Other party this
Stipulation and Order including all attachments. He or she said they understood this Stipulation and Order and its
attachments before signing them.

Date Interpreter’s printed name Interpreter’s signature

ORDER

10. The Court approves the terms stipulated and agreed to in this document and all attachments, and makes them court orders.

Date: Judicial Officer of the Superior Court

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PB-4062 REV 01/01/13 CONSERVATORSHIP STIPULATION AND PROPOSED ORDER Page 1 of 2