San Luis Obispo — PR012

Source: https://www.slo.courts.ca.gov/documents/san-luis-obispo/PR_012_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:

DECLARATION OF SERVICE ON PETITION FOR REAPPOINTMENT OF LPS
CONSERVATOR

I, __________________ (print name), am at all times herein mentioned a citizen of the
United States and resided at ______________________________________(address).

I am over the age of 18 and NOT a party to this action.

I gave or mailed a copy of the petition for Reappointment of LPS Conservator as
follows:

On _________, _____ □ Gave a copy of the above San Luis Obispo County (month/date/ year). Director of Mental Health documents to Or □ mailed, nd 2180 Johnson Ave, 2 Floor a copy of the above San Luis Obispo, CA 93401 documents to: On _________, _____ □ Gave a copy of the above San Luis Obispo County Public (month/date/ year). Guardian documents to Or □ mailed, P.O. Box 1489 a copy of the above San Luis Obispo, CA 93406 documents to: On _________, _____ □ Gave a copy of the above Maguire and Ashbaugh (month/date/ year). San Luis Obispo County Public documents to Or □ mailed, Defender a copy of the above 991 Osos Street, Suite A documents to: San Luis Obispo, CA 93401

Form Adopted for Optional Use DECLARATION OF SERVICE Page 1 of 2San Luis Obispo Superior Court Local Form PR012 Rev. 1/1/15

LPS CONSERVATORSHIP OF: CASE NUMBER

On _________, _____ □ Gave a copy of the above Conservatee (list address) (month/date/ year). NOTE citation must also be documents to Or □ mailed, personally served a copy of the above documents to:

On _________, _____ □ Gave a copy of the above (Care facility- list address) (month/date/ year). documents to Or □ mailed, a copy of the above documents to:

On _________, _____ □ Gave a copy of the above (Any others, such as family, or (month/date/ year). private attorney of documents to Or □ mailed, conservatee - list address) a copy of the above documents to:

On _________, _____ □ Gave a copy of the above (Any others, such as family, or (month/date/ year). private attorney of documents to Or □ mailed, conservatee - list address) a copy of the above documents to:

On _________, _____ □ Gave a copy of the above (Any others, such as family, or (month/date/ year). private attorney of documents to Or □ mailed, conservatee - list address) a copy of the above documents to:

Other parties served are listed on Attachment 1.

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

Date: ________________

_____________________________ ______________________________
(Print Name) (Signature of party serving notice)

Form Adopted for Optional Use DECLARATION OF SERVICE Page 2 of 2San Luis Obispo Superior Court Local Form PR012 Rev. 1/1/15