Marin — PR015

Source: https://www.marin.courts.ca.gov/system/files/pr015-confidentialcontactinformationn6-15n.pdf

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address): FOR COURT USE ONLY

TELEPHONE NO: FAX NO (Optional): EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MARIN 3501 Civic Center Drive P.O. Box 4988 San Rafael, CA 94913-4988

(PROPOSED) CONSERVATORSHIP OF: Person Limited Estate of:

CASE NUMBER CONFIDENTIAL
CONTACT INFORMATION PURSUANT TO
Probate Code Sections 2250.6(a)(1)(A)(B)(C), 1826(a)(1)(2), 1851(a)

Hearing Date: _______________________________

Proposed Conservator Review Successor Conservator

This form must be filed with petitions for the appointment of a conservator, appointment of a successor conservator, and with subsequent accountings. Provide additional pages, if necessary.

SPECIAL PROBLEMS RELATED TO INVESTIGATION (i.e. language, personal safety, communication):

Please note, the Court must be notified immediately of address changes of Conservatees and Conservators.

1. (PROPOSED) CONSERVATEE:

Name:

Address:

Home No.: _________________________ Work No.: ________________________ Cell No.:

Day Program (if appropriate):

2. PETITIONER (if different from Proposed Conservator):

Name:

Address:

Home No.: _________________________ Work No.: ________________________ Cell No.:

Relationship to (Proposed Conservatee):

3. (PROPOSED) CONSERVATOR:

Name:

Address:

Home No.: _________________________ Work No.: ________________________ Cell No.:

Relationship to (Proposed Conservatee):

PR015 (Rev. 6/24/15) CONFIDENTIAL CONTACT INFORMATION Page 1 of 3

THE INFORMATION SOUGHT IN THE BALANCE OF THIS FORM RELATES TO THE PROPOSED CONSERVATEE

4. SPOUSE OR REGISTERED DOMESTIC PARTNER: Spouse Registered Domestic Partner

Name:

Address:

Home No.: _________________________ Work No.: ________________________ Cell No.:

5. RELATIVES WITHIN THE FIRST DEGREE (ADULT CHILDREN, PARENTS):

Name:

Address:

Home No.: _________________________ Work No.: ________________________ Cell No.:

Relationship to (Proposed Conservatee):

Name:

Address:

Home No.: _________________________ Work No.: ________________________ Cell No.:

Relationship to (Proposed Conservatee):

Name:

Address:

Home No.: _________________________ Work No.: ________________________ Cell No.:

Relationship to (Proposed Conservatee):

6. RELATIVES WITHIN THE SECOND DEGREE (SIBLINGS, GRANDPARENTS, ADULT GRANDCHILDREN):

Name:

Address:

Home No.: _________________________ Work No.: ________________________ Cell No.:

Relationship to (Proposed Conservatee):

Name:

Address:

Home No.: _________________________ Work No.: ________________________ Cell No.:

Relationship to (Proposed Conservatee):

Name:

Address:

Home No.: _________________________ Work No.: ________________________ Cell No.:

Relationship to (Proposed Conservatee):

PR015 (Rev. 6/24/15) CONFIDENTIAL CONTACT INFORMATION Page 2 of 3

7. RELATIVES PURSUANT TO PROBATE CODE § 1821(b) (ANY OTHER BIOLOGICAL OR LEGAL RELATIVES OF THE CONSERVATEE NOT LISTED ABOVE):

Name:

Address:

Home No.: _________________________ Work No.: ________________________ Cell No.:

Relationship to (Proposed Conservatee):

Name:

Address:

Home No.: _________________________ Work No.: ________________________ Cell No.:

Relationship to (Proposed Conservatee):

8. NEIGHBORS:

Name:

Home No.: _________________________ Work No.: ________________________ Cell No.:

Name:

Home No.: _________________________ Work No.: ________________________ Cell No.:

9. FRIENDS:

Name:

Home No.: _________________________ Work No.: ________________________ Cell No.:

Name:

Home No.: _________________________ Work No.: ________________________ Cell No.:

10. FINANCIAL INFORMATION: Type of Trust: Living Irrevocable Special Needs Approximate Value of Trust:

Name of Trustee:

Address:

City/State/Zip: ____________________________________________________ Home No.: Is there a will? Yes No Date the trust/will was established:

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