San Benito — SB-PR-4

Source: https://www.sanbenito.courts.ca.gov/system/files/conservatees-information-review-hearing-rev-1.pdf

SB-PR-4 CONFIDENTIAL (DO NOT ATTACH TO PETITION) ATTORNEY OR PARTY WITHOUT AN ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY NAME: ADDRESS: CITY, STATE, ZIP:

TELEPHONE NO: FAX NO. (Optional):

EMAIL ADDRESS:

ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BENITO STREET ADDRESS: 450 FOURTH STREET MAILING ADDRESS: 450 FOURTH STREET CITY AND ZIP CODE: HOLLISTER, CA 95023 BRANCH NAME: 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.):

Conservatee: Name: Address: 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: Phone No.: Contact Person: Conservator: Name: Relationship: Address: Phone No.: Work: Cell:

CONSERVATEE’S INFORMATION & LIST OF RELATIVES - CONFIDENTIAL
(Probate Conservatorship) Probate Code, § 1826

Form Adopted for OPTIONAL USE
Superior Court of San Benito
SB‐PR‐3

SB-PR-4 Email: CONSERVATORSHIP OF (Name): CASE NUMBER:

Co-Conservator: Name: Relationship: Address: Phone No.: Work: Cell: Email:

Attorney for Conservator: Name/Firm: Address: Phone No.: Fax No.: Email:

Attorney for Co-Conservator: (if applicable) Name/Firm: Address: Phone No.: Fax No.: Email:

Attorney for Conservatee: (if applicable) Name/Firm: Address: Phone No.: Fax No.: Email:

Conservatee’s Physician/Practitioner: Name: Institution (if applicable): Address: Phone No.: Email:

CONSERVATEE’S INFORMATION & LIST OF RELATIVES - CONFIDENTIAL
(Probate Conservatorship) Probate Code, § 1826

Form Adopted for OPTIONAL USE
Superior Court of San Benito
SB‐PR‐3

SB-PR-4

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 2 nd degree relatives (brothers, sisters, grandparents & grandchildren). If there is a close friend or neighbor who is involved, please list.

Name: Relationship: Address: Home Phone No.: Work Phone No.: Email:

Name: Relationship: Address: Home Phone No.: Work Phone No.: Email:

Name: Relationship: Address: Home Phone No.: Work Phone No.: Email:

Name: Relationship: Address: Home Phone No.: Work Phone No.: Email:

CONSERVATEE’S INFORMATION & LIST OF RELATIVES - CONFIDENTIAL
(Probate Conservatorship) Probate Code, § 1826

Form Adopted for OPTIONAL USE
Superior Court of San Benito
SB‐PR‐3

SB-PR-4

CONSERVATORSHIP OF (Name): CASE NUMBER:

Name: Relationship: Address: Home Phone No.: Work Phone No.: Email:

Name: Relationship: Address: Home Phone No.: Work Phone No.: Email:

Additional pages attached (check box if applicable).

NOTE: This form is to be filed by: 1. The Proposed Conservator for the review hearing. 2. 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 to: Superior Court of San Benito County Probate Clerk, Araceli Ceja 450 Fourth Street Hollister, CA 95023 831-636-4057 107

CONSERVATEE’S INFORMATION & LIST OF RELATIVES - CONFIDENTIAL
(Probate Conservatorship) Probate Code, § 1826

Form Adopted for OPTIONAL USE
Superior Court of San Benito
SB‐PR‐3