San Diego — Confidential Financial Statement Coversheet PR-121C (Rev: 01/21)

Source: https://www.sdcourt.ca.gov/sites/default/files/sdcourt/generalinformation/forms/probateforms/pr121c.pdf

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CONFIDENTIAL

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

TELEPHONE NO.: FAX NO. (Optional):

EMAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, CENTRAL COURTHOUSE, 1100 UNION ST., SAN DIEGO, CA 92101

CONSERVATORSHIP GUARDIANSHIP OF:

CASE NUMBER
CONFIDENTIAL FINANCIAL STATEMENT COVERSHEET

NOTE: This form may only be used for guardianship/conservatorship accountings where the financial statements are being submitted confidentially. The Financial Statement Coversheet (SDSC Form #PR-121) must be used in all other case types or in guardianships/conservatorships where the financial statements are not confidential.

The financial statement for the accounting is attached.

Accounting period:

AFFIDAVIT RE CONFIDENTIALITY The attached financial statement(s) contains the ward’s or conservatee’s social security number. The attached financial statement(s) contains other personal information regarding the ward or conservatee that would not ordinarily be disclosed in a court accounting, an inventory and appraisal, or other nonconfidential pleadings filed in the action. Specify: Contains entire account number(s). Other: ______________________________________

VERIFICATION RE ELECTRONIC STATEMENTS

The attached statements were received in electronic form and printed/attached without alteration.

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

Date:

Type or print name of Guardian/Conservator Signature of Guardian/Conservator

Type or print name of Guardian/Conservator Signature of Guardian/Conservator

SDSC PR-121C (New 1/21) CONFIDENTIAL FINANCIAL STATEMENT COVERSHEET Prob. Code § 2620(c) & Optional Form SDSC Local Rules, rule 4.15.2 Clear This Form