Los Angeles local probate form — BRANCH NAME: Stanley Mosk Courthouse (LASC PRO 057)

Source: https://lascpubstorage.blob.core.windows.net/forms/Forms%20Comprehensive%20List/LASC%20PRO%20057.pdf

NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY FOR COURT USE ONLY

E-MAIL ADDRESS:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES BRANCH NAME: Stanley Mosk Courthouse STREET ADDRESS: 111 N. Hill Street CITY AND ZIP CODE: Los Angeles, CA 90012-3014

APPLICATION FOR APPOINTMENT TO COURT APPOINTED COUNSEL PANEL CONFIDENTIAL – FOR COURT USE ONLY

I, , apply for appointment to the Court Appointed Counsel Panel and declare as follows:

1. I have read and agree to comply with California Rules of Court (CRC) sections 7.1101 through 7.1105 and Superior Court of Los

Angeles County Rules 4.123 through 4.127. Further, I understand and agree that an Annual Compliance Certification for Court Appointed Counsel Panel (Superior Court of Los Angeles County Form Number PRO-058) must be filed yearly as set forth in California Rules of Court (CRC) 7.1105.

2. I am submitting Certification of Attorney Qualifications (Judicial Council Form Number GC-010) with this application along with the

following:

• Proof of Professional Liability Insurance Policy attached
Initials

• Proof of Compliance with the educational requirements attached
Initials

3. I request appointment to the Probate Court Appointed Counsel Panel in the following areas: ☐ Conservator of the Person & Estate * ☐ Limited conservatorship for developmentally disabled adults * Completion date of last Limited Conservatorship Program: ____________________ ☐ LPS Conservatorship ☐ Guardianship of the Person & Estate (Minor’s Counsel) * ☐ Capacity determinations and health care decisions for adult without Conservators (Probate Code § 3200) ☐ Tuberculosis detention proceedings ☐ Guardian Ad litem Completion of last Guardian ad litem Program: _______________________________ 10 years of practice? ☐ Yes or ☐ No If so, give specific court information, type of case served as GAL; fiduciary case name; case number; and date: _________________________________ ________________________________________________________________________ ________________________________________________________________________ ☐ Other: ☐ Medi-Cal planning (Probate Code §3100 and §3600) ☐ Compromises / Judgments, special needs trusts, minors’ trusts

*Attorneys accepting appointments as counsel in conservatorships and guardianship proceedings must meet the qualifications and continuing education requirements set forth in California Rules of Court Rule 7.1102 and 7.1103.

APPLICATION FOR APPOINTMENT TO COURT APPOINTED COUNSEL PANEL

SCLAC PRO 057 Rev. 04/26 For Mandatory Use

4. I speak the following foreign languages:

Members of my staff speak the following foreign languages:

5. I am willing to accept court appointments in matters pending in the following Superior Court Districts: ☐North – North District ☐East – Northeast, East, Southeast, North Central, and South-Central Districts ☐Central - Central District, and any out of county conservatees. – Northwest, South, Southwest, West, and North Valley Districts ☐West

6. Attorney Compensation in Superior Court of Los Angeles County Proceedings I have reviewed and agreed to be bound by the terms of Superior Court of Los Angeles County General Order Re: Probate Court Appointed Counsel Panel Appointments dated March 15,2022 concerning the court’s policies of accepting (or continuing) any court appointed counsel appointments to represent proposed conservatees, conservatees, proposed wards or wards or any other individual in Superior Court of Los Angeles County Proceedings.

7. Approximately _______ % of my current practice consists of estate planning, estate administration, trusts, guardianship, or conservatorship matters.

8. I have the following special skills, training and/or experience relating to decedent estate and trust administrations, conservatorship,

guardianship matters:

9. I am a Certified Specialist in: ☐Estate Planning, Probate and Trust Law ☐Taxation ☐Family Law ☐Other:

10. If at any time while I am a member of this panel, my status as a member of the State Bar changes or I no longer am covered by professional liability insurance, I agree to notify the Court, in writing, within ten (10) days of that change.

11. I understand that submission of an Attorney Application for Appointment to Probate Court Appointed Counsel Panel and/or Annual Compliance Certification for Probate Court Appointed Counsel Panel Attorneys does not guarantee entitlement to appointments as counsel and acknowledge that all appointments of court appointed counsel are entirely within the discretion of the Superior Court of Los Angeles County.

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

SIGN

Date Signature

Bar Number Printed Name

APPLICATION FOR APPOINTMENT TO COURT APPOINTED COUNSEL PANEL

SCLAC PRO 057 Rev. 04/26 For Mandatory Use