Stanislaus — Conservatorship packet

Source: https://www.stanislaus.courts.ca.gov/system/files/forms-and-filings/conservatorship-packet.pdf

Sparse pages use OCR; original PDF remains authoritative.

www -stanislaus.courts.ca.gov (209)530-3100 Revised 1/1/25 CONSERVATORSHIP PACKET This packet contains forms required to begin a Conservatorship proceeding in Stanislaus County Superior Court. These forms may be used for three types of petitions: Conservatorship of the Person, Conservatorship of the Estate, and Limited Conservatorship. If you need a Temporary Conservatorship, you will need to purchase a separate packet. There are situations, however, for which there are no forms. In such a situation, the petition, declaration or other documents must be prepared on pleading paper in the proper format. Pleading paper is available for purchase at the stationery stores or from the Clerk of the Court. HELP Counsel and self-represented parties are obligated to review and comply with Local Rules regarding Conservatorship proceedings located on the Superior Court website listed below. Judicial Council forms, local forms and information are available in the Clerk’s Office, the Stanislaus County Law Library located at 1101 13** Street, Modesto, and on the following websites: Stanislaus County Superior Court http: //www.stanislaus.courts.ca.gov Local forms http: //www.stanislaus.courts.ca.qov/forms Judicial Council’s Self-Help website http://www.courts.ca.gov/selfhelp For more information on Libraries, Websites, or Self-Help Legal Books http://www.courts.ca.gov/selfhelp/lowcost/libraries.html There are books available on how to do a Conservatorship at the Public Library, the Law Library and in Bookstores. Local rules are available there and online at the Superior Court’s website. For duties and responsibilities of the Conservator and rights of the Conservatee, please refer to your Handbook for Conservators, which is required to be purchased when you file your Petition. It is also available online at: http://www.courtinfo.ca.gov/selfhelp/seniors/duties.htm#rights

FREQUENTLY ASKED QUESTIONS Persons handling their own cases, (self-represented), are required to prepare and present their pleading, (court documents), in complete and proper form, without help from the court staff. This office is prohibited from giving legal advice in any manner. Doing so would constitute acting as an attorney or legal counsel. Questions on legal matters regarding the appropriate form or its proper completion and presentation should be referred to an attorney. PREPARATION You are required to bring in one (1) original, plus two (2) copies of all documents. Whether typed or hand printed, your papers must be completed in blue or black ink, be legible and clear enough to photocopy. The petitioner’s name, address and telephone number must be placed in the space in the upper left hand corner of each form. Pleadings are to be dated and signed before being presented for filing EXCEPT for the Letters of Conservatorship. Each form must have the court name and location in the heading as below: SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS 801 107 STREET, 4™ FLOOR MODESTO, CA 95354

PLEASE FILL OUT THIS QUESTIONNAIRE AND RETURN TO THE FOLLOWING ADDRESS: STANISLAUS COUNTY SUPERIOR COURT INVESTIGATOR'S OFFICE PO BOX 3488, 800 11TH STREET RM 221 MODESTO, CA 95353 CONSERVATORSHIP QUESTIONNAIRE CASE NUMBER CONSERVATEE NAME: AGE: DOB: ADDRESS: OWN OR RENT? MONTHLY MORTGAGE PAYMENT OR RENT TELEPHONE # CARE GIVER/BOARD & CARE/FACILITY NAME: BIRTHPLACE PHYSICIAN: SSAN#: IS THE CONSERVATEE A CLIENT OF VMRC, OTHER REGIONAL CENTER? IF YES, PLEASE GIVE THE NAME OF THE CENTER, CASE MANAGER, ADDRESS, TELEPHONE #, ATTENDANCE SCHEDULE ETC. IS THE CONSERVATEE ATTENDING ANY OTHER SCHOOL, WORK OR DAY PROGRAM? IF YES, PLEASE GIVE THE NAME OF THE CENTER, CASE MANAGER, ADDRESS TELEPHONE #, ATTENDANCE SCHEDULE, ETC. CONSERVATEE’ S MONTHLY INCOME: SOURCE(S) OF INCOME: CHECKING ACCT. BAL: SAVINGS ACCT. BAL.: OTHER ASSETS (BURIAL PLAN/TRUST, PLOT, ETC.): CONSERVATOR (S) : NAME: AGE: DOB: ADDRESS: EMAIL: _ _ —_ HOME TELEPHONE: EMPLOYER: WORK TELEPHONE: ADDRESS: HAVE YOU EVER BEEN CONVICTED OF A FELONY? IF YES, PROVIDE DATE, COUNTY & DETAILS. HAVE YOU EVER FILED FOR BANKRUPTCY? IF YES, PROVIDE DATE, & DETAILS. I declare under the penalty of perjury the foregoing is true and correct. PLEASE ADD ANY ADDITIONAL INFORMATION YOU MAY FEEL IS PERTINENT. THANK YOU FOR YOUR ASSISTANCE. (Telephone calls to the Court Investigator's Office will be accepted between 10 a.m. and 3 p.m. at (209) 530-3189) CON02 (Mandatory Form) Rev 12/25

PLEASE FILL OUT THIS QUESTIONNAIRE AND RETURN TO THE FOLLOWING ADDRESS: DATED: By Conservator (209) 530-3189) PLEASE ADD ANY ADDITIONAL INFORMATION YOU MAY FEEL IS PERTINENT. THANK YOU FOR YOUR ASSISTANCE. (Telephone calls to the Court Investigator's Office will be accepted between 10 a.m. and 3 p.m. at CON02 (Mandatory Form) Rev 07/25

GC-310 ATTORNEY OR PARTY WITHOUT ATTORNEY ST ATE BAR NO. —_ FOR COURT USE ONLY NAME: FIRM NAME: STREET ADDRESS: city: STATE ZIP CODE! TELEPHONE NO.: FAX NO E-MAIL ADDRESS: ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS STREET ADDRESS: 801 10TH STREET, 4TH FLOOR MAILING ADDRESS: 801 10TH STREET, 4TH FLOOR city and zipcode: MODESTO, CA 95354 BRANCH NAME: CONSERVATORSHIP OF (name): (PROPOSED) CONSERVATEE PETITION FOR APPOINTMENT OF [~~] SUCCESSOR CASE NUMBER: PROBATE CONSERVATOR OF THE [] PERSON [] ESTATE co Limited Conservatorship HEARING DATE AND TIME: DEPT.:

1. Petitioner (name): requests that a. (Name): (Telephone): (Address): be appointed [] successor [| conservator [*] limited conservator of the PERSON of the (proposed) conservatee and Letters issue upon qualification. b. (Name): (Telephone): (Address): be appointed [] successor [] conservator limited conservator of the ESTATE of the (proposed) conservatee and Letters issue upon qualification. c. bond not be required [} because the proposed —[] successor conservaior is a corporate fiduciary or an exempt government agency {] for the reasons stated in Attachment 1c. (2) [-] bond be fixed at: $ to be furnished by an authorized surety company or as otherwise provided by law. (Specify reasons in Attachment 1c if the amount is different from the minimum required by Probate Code section 2320.) (3) [ $ in deposits in a blocked account be allowed. Receipts will be filed. (Specify institution and location) d. [] orders authorizing independent exercise of powers under Probate Code section 2590 be granted. Granting the proposed {| successor conservator of the estate powers to be exercised independently under Probate Code section 2590 would be to the advantage and benefit and in the best interest of the conservatorship estate. (Specify orders, powers, and reasons in Attachment 1d.) e. [] orders relating to the capacity of the (proposed) conservatee under Probate Code section 1873 or 1901 be granted. (Specify orders, facts, and reasons in Attachment Te.) f. {~] orders relating to the powers and duties of the proposed {] successor conservator of the person under Probate Code sections 2351-2358 be granted. (Specify orders, facts, and reasons in Attachment 1f.) g. {___] the (proposed) conservatee be adjudged to lack the capacity to give informed consent for medical treatment or healing by prayer and that the proposed _[.__}] successor conservator of the person be granted the powers specified in Probate Code section 2355. (Complete item 9 on page 6.) Do NOT use this form for a temporary Conservatorship Page 1018 Form Adopted for Mandatory Use Probate Code. §§ 1820 jucical CounciiolCatfomia, | PETITION FOR APPOINTMENT OF PROBATE CONSERVATOR aw cen ete (Probate—-Guardianships and Conservatorships) :

GC-310 CONSERVATORSHIP OF CASE NUMBER: (name):

• (PROPOSED) CONSERVATFF _

1. h. [~] (for limited conservatorship only) orders relating to the powers and duties of the proposed limited {} successor" conservator of the person under Probate Code section 2351.5 be granted. (Specify orders, powers, and duties in Attachment 1h and complete item 1j.) i. [} (for limited conservatorship only) orders relating to the powers and duties of the proposed limited |] suecessor* conservator of the estate under Probate Code section 1830(b) be granted. (Specify orders, powers, and duties in Attachment 1i and complete item 1j.) J. [__] (for limited conservatorship only) orders limiting the civil and legal rights of the (proposed) limited conservatee be granted. (Specify limitations in Attachment 1).) k. [] orders authorizing placement or treatment for a major neurocognitive disorder (such as dementia) as specified in the Attachment Requesting Special Orders Regarding a Major Neurocognitive Disorder (form GC-31 3) under Probate Code section 2356.5 be granted. A Capacity Declaration—Conservatorship (form GC-335) and Major Neurocognitive Disorder Attachment to Capacity Detlaration— Conservatorship (form GC-335A), executed by a licensed physician or by a licensed psychologist acting within the scope of his or her license with at least two years experience diagnosing m neurocognitive disorders (including demeniia), [_] are filed herewith. [] will be filed before the hearing. jor Or {] (appointment of successor conservator only) will not be filed because an order relating to placement or treatment for a major neurocognitive disorder (such as dementia) was filed on (date): . That order has neither expired by its terms nor been revoked. i _] other orders be granted. (Specify in Attachment-4.) ante enone
2. (Proposed) conservatee is (name): (Telephone): Current address}:
3. a. [] Jurisdictional facts (initial appointment only) The proposed conservatee has no conservator in California and is a (4) resident of California and (a) ["] a resident of this county. (b) [_} not a resident of this county, but commencement of the conservatorship in this county is in the best interests of the proposed conservatee for the reasons specified in Attachment 3a. S sident of California but (a) is temporarily living in this county, or (b) [~~] has property in this county, or (c) [-] commencement of the conservatorship in this county is in the best interest of the proposed conservatee for the reas pecified in Attachment 3a. b. Petitioner (answer items (1) and (2) and check all other items that apply) (4) [] is [is not a creditor or an agent of a creditor of the (proposed) conservatee (2) [_} is {J isnot a debtor or an agent of a debtor of the (proposed) conservatee. (3) [-] is the proposed Cy successor conservator. (4) {] is the (proposed) conservatee. (If this item is not checked, you must also complete item 3f.) (5) [_] is the spouse of the (proposed) conservatee. (You must also complete item 6.) (6) [] is the domestic partner or former domestic partner of the (proposed) conservatee. (You must also complete item 7.) (7) [-] is a relative of the (proposed) conservatee as (specify relationship): (8) [] is an interested person or friend of the (proposed) conservatee (9) [] is a state or local public entity, officer, or employee. (10){] is the guardian of the proposed conservatee. (41)[] isabank — [7] is another entity authorized to conduct the business of a trust company. (12){] is a professional fiduciary within the meaning of Business and Professions Code section 6501(f) who is licensed by the Professional Fiduciaries Bureau of the Department of Consumer Affairs. Petitioner's license number is provided in item 1 on page 1 of the attached Professional Fiduciary Attachment. (Use form GC-210(A-PF)/GC-310(A-PF) for this attachment. You must also complete item 2 on page 2 of that form and item 3d below.)

• See item 5b on page 4. PETITION FOR APPOINTMENT OF PROBATE CONSERVATOR (Probate—Guardianships and Conservatorships) GC-310 [Rev. January 1 2019) Page 2 of 8

GC-310 CONSERVATORSHIP OF CASE NUMBER: (name): (PROPOSED) CONSERVATEE 3. GC-310 Rev, Janvary 1. 2018] Proposed successor conservator is (check all that apply) (1) [] anominee. (Affix nomination as Attachment 3c(1).) (2) [] the spouse of the (proposed) conservatee. (You must also complete item 6.) (3) [] the domestic partner or former domestic partner of the (proposed) conservatee. (You must also complete item 7.) (4) [] arelative of the (proposed) conservatee as (specify relationship): ( ( ( NO 5) [[7] abank. [] another entity authorized to conduct the business of a trust company. 6) {] a nonprofit charitable corporation that meets the requirements of Probate Code section 2104. 7) [] aprofessional fiduciary, as defined in Business and Professions Code section 6501(f). His or her statement concerning licensure or exemption is provided in item 1 on page 1 of the attached Professional Fiduciary Attachment. (Use form GC-210(A-PF)/GC-310(A-PF) for this attachment.) (8) [-] other (specify): Professional Fiduciaries Bureau.) (1) [] Statements of who engaged petitioner, or how petitioner was engaged to file this petition, and a description of any prior relationship petitioner had with the (proposed) conservatee or his or her family or friends, are provided in item 2 on page 2 of the attached Professional Fiduciary Attachment. (Use form GC-210(A-PF)/GC-310(A-PF) for this attachment.) (2) [-] A petition for appointment of a temporary conservator is filed with this petition. That petition contains statements of who engaged petitioner, how petitioner was engaged to file this petition, and a description of any prior relationship petitioner had with the (proposed) conservatee or his or her family and friends. Character and estimated value of the property of the estate (complete items (1) or (2) and (3), (4), and (5)): (1) [-] (For appointment of successor conservator only, if complete Inventory and Appraisal filed by predecessor): Personal properly: $ , per Inventory and Appraisal filed in this proceeding on (specify dates of filing of all inventories and appraisals): (2) [] Estimated value of personal property: $ (3) Annual gross income from (a) real property $ (b) personal property: $ (c) pensions: $ (d) wages: $ (e) public assistance benefits: $ (f) other $ (4) Total of (1) or (2) and (3): $ (5) Real property: $ (a) {| per Inventory and Appraisal identified in item (1) (b) [-_] estimated value ["] Due diligence (complete this item if the (proposed) conservatee is not a petitioner): (1) Efforts to find the (proposed) conservatee’s relatives or reasons why it is not feasible to contact any of them are described on Attachment 3f(1) (2) Statements of the (proposed) conservatee's preferences concerning the appointment of any (successor) conservator and the appointment of the proposed (su or) conservator or reasons why it is not feasible to ascertain those preferences are contained on Attachment 3f(2) PETITION FOR APPOINTMENT OF PROBATE CONSERVATOR (Probate—Guardianships and Conservatorships)

|CONSERVATORSHIP OF - CASE NUMBER

(name): (PROPOSED) CONSERVATEE 3. g. So far as known to petitioner, a conservatorship or equivalent proceeding concerning the proposed conservatee iz has not “] has. been filed in another jurisdiction, including a court of a federally-recognized Indian tribe with jurisdiction (see Prob. Code, § 2031(b)). (If you answered “has, “identify the jurisdiction and state tho date the case was filed): 4. (Proposed) conservatee a (} is | (7) isnot a patient in or on leave of absence from a state institution under the jurisdiction of the California Department of State Hospitals or the California Department of Developmental Services (specify state institution): b. [] is receiving or entitled to receive [] is neither receiving nor entitled to receive enefits from the U.S. Department of Veterans Affairs (estimate amount of monthly benefit payable): c. [__] is [7] is not, so far as is known to petitioner, a member of a federally recognized Indian tribe. (If you answered “is,” complete items (1)-(4)): (1) Name of tribe: (2) Location of tribe (if the tribe is located in more-than one state, the state that is the tribe’s principal location): (3) The proposed conservatee [] does [[] doesnot reside on tribal land.* (4) So far as known to petitioner, the proposed conservatee [~] owns [7] does not own property on tribal land. a o [__] Proposed conservatee (initial appointment of conservator only) (1) [-] is an adult. (2) []} will be an adult on the effective date of the order (date): (3) [._] is a married minor. 4) [] is a minor whose marriage has been dissolved. b. [-"] Vacancy in office of conservator (appointment of successor conservator only. A petition for appointment of a limited conservator after the death of a predecessor is a petition for initial appointment. (Prob. Code, § 1860.5(a)(1).) There is a vacancy in the office of conservator of the [~] person [] estate for the reasons {] specified in Attachment 5b. [_] specified below.

• “Tribal land” is land that is, with respect to a specific Indian tribe and the members of that tribe, “Indian country,” as defined in 18 U.S.C. § 1451. GC-310 (Rev. January 1. 2019] Page 4 of 8 PETITION FOR APPOINTMENT OF PROBATE CONSERVATOR (Probate—Guardianships and Conservatorships)

CONSERVATORSHIP OF : CASE NUMBER (name): (PROPOSED) CONSERVATEE 5. c. (Proposed) conservatee requires a conservator and is —] unable to properly provide for his or her personal needs for physical health, food, clothing, or shelter. Supporting facts are specified in Attachment 5c(1)— [[] as follows: (2) [_] substantially unable to manage his or her financial resources or to resist fraud or undue influence. Supporting facts are _] specified in Attachment 5c(2) ~} as follows: eons PETITION FOR APPOINTMENT OF PROBATE CONSERVATOR Page 5 of 8 (Probate—Guardianships and Conservatorships) GC-310 [Rev tony

GC-310

|CONSERVATORSHIP OF

(name): CASE NUMBER: (PROPOSED) CONSERVATEE 5. d. [] (Proposed) conservatee voluntarily requests the appointment of a {-] successor conservator. (Specify facts showing good cause in Attachment 5(d).) e. [] Confidential Supplemental Information (form GC-312) is filed with this petition. (Initial appointment of conservator only. All petitioners must file this form except banks and other entities authorized to do business as a trust company.) f. (Proposed) conservatee [| does [[] doesnot havea developmental disability as defined in Probate Code section . 1420. Petitioner is aware of the requirements of Prohate Cade section 1827.5. (Specify the nature and degree of the alleged disability in Attachment 5f). 6. Petitioner or proposed successor conservator is the spouse of the (proposed) conservatee. (If this statement is true, you must answer a or b. ) a. The (proposed) conservatee's spouse is not a party to any action or proceeding against the (proposed) conservatee for iegal separation, dissolution of marriage, annulment, or adjudication of nullity of their marriage. b. [-] Although the (proposed) conservatee's spouse is a party to an action or proceeding against the (proposed) conservatee for legal separation, dissolution, annulment, or adjudication of nullity of their marriage, or has obtained a judgment in one of these proceedings, it is in the best interest of the (proposed) conservatee that: (1) a [] successor conservator be appointed. (2) the spouse be appointed as the [] successor _ conservator. (/f you checked item 6b(1) or (2) or both, specify the facts and reasons in Attachment 6b.) 7. (] Petitioner or proposed [] successor conservator is the domestic partner or former domestic partner of the (proposed) conservatee. (If this statement is irue, you must answer a or b.) a. [] The domestic partner of the (proposed) conservatee has not terminated and does not intend to terminate the domestic partnership. b. [[] Although the domestic partner or former domestic partner of the (proposed) conservatee intends to terminate or has terminated the domestic partnership, it is in the best interest of the (proposed) conservatee that (4) [Ja [(] successor conservator be appointed. (2) the domestic partner or former domestic partner be appointed as the [] successor conservator (If you checked item 7b(1) or (2) or both, specify the facts and reasons in Attachment 7b.) 8. (Proposed) conservatee (check ail that apply) a. will attend the hearing AND [___] is the petitioner _] is not the petitioner AND = [__] has has not nominated the proposed [ successor conservator. b. [] (initial appointment of conservator only) is able but unwilling to attend the hearing AND [~] does [] does not wish to contest the establishment of a conservatorship, [~~] does {__]} does not object to the proposed conservator, AND [—} does {| does not prefer that another person act oes does per c. [__] (initial appointment of conservator only): is unable to attend the hearing because of medical inability. A Capacity Declaration—Conservatorship (form GC-335), executed by a licensed medical practitioner or an accredited religious practitioner ["] is filed with this petition. _] will be filed before the hearing d. [~~] (initial appointment of conservator only) is not the petitioner, is out of state, and will not attend the hearing. e. (appointment of successor conservator only) will not attend the hearing. 9. ["} Medical treatment of (proposed) conservatee a. There is no form of medical treatment for which the (proposed) conservatee has the capacity to give an informed consent. b. A Capacity Declaration—Conservatorship (form GC-335) executed by a licensed physician or by a licensed psychologist acting within the scope of his or her licensure, stating that the (proposed) conservatee lacks the capacity to give informed consent for any form of medical treatment and giving reasons and the factual basis for this conclusion, {~] is filed with this petition. [-_] will be filed before the hearing {} will not be filed for the reason stated in c. c. } (appointment of successor conservator only) The conservatee's incapacity to consent to any form of medical treatment was determined by order filed in this matter on (date): That order has neither expired by its terms nor been revoked. d. (Proposed) conservatee [] is [-_] is not an adherent of a religion that relies on prayer alone for healing, as defined in Probate Code section 2355(b). GC-310 [Rev. January 1, 2019) PETITION FOR APPOINTMENT OF PROBATE CONSERVATOR Page 6 of 8 (Probate—Guardianships and Conservatorships)

CONSERVATORSHIP OF “T CASE NUMBER: (name): i (PROPOSED) CONSERVATEE 10.{] Temporary conservatorship Filed with this petition is a Petition for Appointment of Temporary Conservator (form GC-111) 11. (Proposed) conservatee's relatives The names, residence addresses, and relationships of the spouse or registered domestic partner and the second-degree relatives of the (proposed) conservatee (his or her parents, grandparents, children, grandchildren, and brothers and sisters), so far as known to petitioner, are a. [] listed below. b. {~] not known, or no longer living, so the (proposed) conservatee’s deemed relatives under Probate Code section 1821(b) (1}(4) are listed below. Name and relationship to conservatee Residence address (1) (2) (3) (4) (5) (7) (8) (10) (11) (12) (13) (14) {"} Continued on Attachment 11. GE3H0 [Rev January 12019) PETITION FOR APPOINTMENT OF PROBATE CONSERVATOR Page 7 of 8 (Probate—Guardianships and Conservatorships)

GC-310 CONSERVATORSHIP OF CASE NUMBER: (name): (PROPOSED) CONSERVATEE 12.[] Confidential conservator screening form Submitted with this petition is a Confidential Conservator Screening Form (form GC-314) completed and signed by the proposed successor conservator. (Required for all proposed conservators except banks and trust companies.) 13.[] Court investigator Filed with this petition is a proposed Order Appointing Court Investigator (form GC-330). 14. Number of pages attached: Date:

(TYPE OR PRINT NAME OF ATTORNEY FOR PETITIONER) (SIGNATURE OF ATTORNEY FOR PETITIONER) (All petitioners must also sign (Prob. Code, § 1020; Cal. Rules of Court, rule 7.103).)

| 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 PETITIONER) (SIGNATURE OF PETITIONER) (TYPE OR PRINT NAME OF PETITIONER) . (SIGNATURE OF PETITIONER) a PETITION FOR APPOINTMENT OF PROBATE CONSERVATOR Page 8 of 8 (Probate—Guardianships and Conservatorships) GC-310 [Rev. January 1, 2019]

CONFIDENTIAL (DO NOT ATTACH TO PETITION) GC-312 ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY NAME: FIRM NAME: STREET ADDRESS CITY: STATE: ZiP CODE: TELEPHONE NO.: FAX NO. EMAIL ADDRESS: ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS STREET ADDRESS: 801 10TH STREET, 4TH FLOOR MAILING ADDRESS: 801 10TH STREET, 4TH FLOOR CITY AND ZIP cope: MODESTO, CA 95354 BRANCH NAME: CONSERVATORSHIP OF (name): PROPOSED CONSERVATEE CONFIDENTIAL SUPPLEMENTAL INFORMATION CASE NUMBER: [] Limited Conservatorship ofthe [] Person [__] Estate 1, 2. 3. HEARING DATE: a. Proposed conservatee (name): b. Date of birth: c. Age: DEPT Time d. Social security number:

|, the person completing this form, am the (check each that applies) | [__] petitioner [| proposed conservator __ in this

proceeding. [~] ABILITY TO PROVIDE PROPERLY FOR PERSONAL NEEDS* The following facts and circumstances supplement and support the petition's assertions that the proposed conservatee is unable to provide properly for personal needs for physical health, food, clothing, or shelter (specify in detail, expanding on the reasons in the petition; give specific examples from the proposed conservatee's daily life showing significant, ongoing behavior patterns): a. Physical health (give examples showing the proposed conservatee's inability to move and exercise, maintain personal hygiene, make and attend routine medical appointments, take medication as prescribed, etc.): [-] Continued in Attachment 3a. b. Food (give examples showing the proposed conservatee’s inability to eat or drink, prepare food, shop for food, etc.): [] Continued in Attachment 3b. c. Clothing (give examples showing the proposed conservatee's inability to get dressed, do laundry, shop for clothing, etc.): [] Continued in Attachment 3c. d. Shelter (give examples showing the proposed conservatee's inability to pay rent or mortgage, pay utility bills, keep house, etc.): [-] Continued in Attachment 3d.

• If any part of item 3 does not apply to the proposed conservatorship, skip it, check box 3 in item 10, and explain why it does not apply.

Jada Counc ot Catone CONFIDENTIAL SUPPLEMENTAL INFORMATION ree aDDe, 120s, 182th GC-312 (Rev. January 1, 2024] (Probate Conservatorship) www.courts.ca.gov

CONFIDENTIAL GC-312 CONSERVATORSHIP OF (name): . CASE NUMBER: PROPOSED CONSERVATEE 4. [_] ABILITY TO MANAGE OWN FINANCIAL RESOURCES* The following facts and circumstances supplement and support the petition’s assertions that the proposed conservatee is substantially unable to manage that person's own financial resources or to resist fraud or undue influence (specify in detail, expanding on the reasons in the petition; give specific examples from the proposed conservatee's daily life showing significant, ongoing behavior patterns): a. Financial resources (give examples of the proposed conservatee's substantial inability to manage money or property): [-] Continued in Attachment 4a. b. Fraud or undue influence (give examples of the proposed conservatee's substantial inability to resist fraud or undue influence): [-] Continued in Attachment 4b.

• If any part of item 4 does not apply to the proposed conservatorship, skip it, check box 4 in item 10, and explain why it does not apply.

5. RESIDENCE (A residence is the place a person would tend to describe as home, for example, an owned or rented single-family house or an apartment in a multiunit building, or an assisted-living, board-and-care, skilled-nursing, or other long-term care facility.) a. The proposed conservatee's residence is a (nature of residence; see above for examples): s The proposed conservatee's residence is located at (street address, city, state): c. The proposed conservatee is currently located at [] the residence in item 5b other (street address, city, state): d. The proposed conservatee's current location is a (nature of current location; see above for examples): e. Ability to live in residence The proposed conservatee is (1) [J living in the residence, and (a) [] is able to continue living there unless circumstances change. (b) [£—] will need to be moved after a conservator is appointed (give specific reasons in item 5f). (c) [] other (specify and give reasons in item 5f). (2) [] not living in the residence, and (a) [-] will be able to return home by (date): (explain in item 5f). (b) [-_] will not return to live there (give specific reasons in item 56). (c) [] other (specify and give reasons in item 56). f. Specific reasons supporting the determination in item 5e about the proposed conservatee's ability to live in the residence: [-_] Continued in Attachment 5f. GC-312 [Rev. January 1, 2024] Page 2 of 4 CONFIDENTIAL SUPPLEMENTAL INFORMATION (Probate Conservatorship)

CONFIDENTIAL GC-312 CONSERVATORSHIP OF (name): PROPOSED CONSERVATEE CASE NUMBER: 6. ALTERNATIVES TO CONSERVATORSHIP | have considered the following alternatives to conservatorship. For each alternative below, either (1) | have attempted that alternative for the length of time and in the manner described and have determined for the reasons explained below that it is unsuitable or does not meet the proposed conservatee's needs; or (2) | have not attempted that alternative and have determined for the reasons explained below that it is unsuitable or does not meet the proposed conservatee's needs and therefore should not be attempted. a. Asupported decisionmaking agreement, as defined in Welfare and Institutions Code section 21001 [_] Continued in Attachment 6a. b. Designation of a health care surrogate under Probate Code section 4711 [-~] Continued in Attachment 6b. c. An advance health care directive under Probate Code section 4600 et seq. [J Continued in Attachment 6c. d. A power of attorney (general or limited, durable or nondurable) under Probate Code section 4000 et seq. [-] Continued in Attachment 6d. e. Atrust, as defined in Probate Code section 82 [-] Continued in Attachment 6e. f. Other alternatives considered or attempted [-] Continued in Attachment 6f. GC-312 Rev. January 1, 2024)

CONFIDENTIAL SUPPLEMENTAL INFORMATION (Probate Conservatorship)

CONFIDENTIAL GC-312 CONSERVATORSHIP OF (name): CASE NUMBER: PROPOSED CONSERVATEE 7. HEALTH OR SOCIAL SERVICES PROVIDED (complete all that apply): a. [] In the year immediately before the petition was filed, the proposed conservatee received the following health services, for example, doctor's visits, medical testing, hospitalizations, surgeries, administration of medication, wound care, or therapy. (describe the services and the circumstances in which they were provided, if none were provided, state none): (-_] Continued in Attachment 7a. b. [] In the year immediately before the petition was filed, the proposed conservatee received the following sociai services, for example, companionship, assistance with personal hygiene, housekeeping, shopping, cooking, or assistance managing finances. (describe the services and the circumstances in which they were provided; if none were provided, state “none’): [J Continued in Attachment 7b. c. [] | do not know, and cannot reasonably find out, what, ifany, [] health services [—] social services were provided to the proposed conservatee in the year immediately before the petition was filed. 8. KNOWLEDGE AND PREFERENCES The proposed conservatee (check ail that apply) a. [] knows about [] does not know about the proposed conservatorship. [[__] | don't know. b. [] agrees with [] does not agree with — the proposed conservatorship. []|don'tknow. [] Not applicable. 9. SOURCE OF INFORMATION The facts, circumstances, and conclusions stated on this form are based, (check all that apply) in item 3, on ["] my own personal knowledge [__] an affidavit (declaration) by another person, attached as Attachment 3. in item 4, on [] my own personal knowledge [] an affidavit (declaration) by another person, attached as Attachment 4. in item 5, on ["] my own personal knowledge [] an affidavit (declaration) by another person, attached as Attachment 5. in item 6,on {[] my own personal knowledge [] an affidavit (declaration) by another person, attached as Attachment 6. in item 7,on [—] my own personal knowledge [] an affidavit (declaration) by another person, attached as Attachment 7. in item 8, on [] my own personal knowledge [__] an affidavit (deciaration) by another person, attached as Attachment 8. e@aooe 10. ITEMS THAT DO NOT APPLY The following items on this form, or parts of those items, do not apply to the proposed conservatorship. (for each item checked, explain why that item or part of an item does not apply): []3 [-]4 [-_] Continued on Attachment 10. 11. Number of pages attached: DECLARATION

| 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) (SIGNATURE) GC-312 [Rev, January 1, 2024] Page 4 of 4 CONFIDENTIAL SUPPLEMENTAL INFORMATION (Probate Conservatorship)

CONFIDENTIAL (DO NOT ATTACH TO PETITION) GC-314 SATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address) _ FOR COURT USE ONLY TELEPHONE NO.: FAX NO. (Optional): €-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS STREET ADDRESS: 801 10TH STREET, 4TH FLOOR MAILING ADDRESS: 801 10TH STREET, 4TH FLOOR city ano ziIP cope: MODESTO; CA 95354 BRANCH NAME: CONSERVATORSHIP OF : ~ | CASE NUMBER: (Name): PROPOSED CONSERVATEE CONFIDENTIAL CONSERVATOR SCREENING FORM HEARING OATE AND TIME: DEPT.: Conservatorship of [] Person [] Estate (—__] Limited Conservatorship The proposed conservator must complete and sign this form, The person requesting appointment of a conservator must submit the completed and signed form to the court with the conservatorship petition. This form must remain confidential. How This Form Will Be Used This form is confidential and will not be a part of the public file in this case. Each proposed conservator must complete and sign a separate copy of this form under rule 7.1050 of the California Rules of Court. The information provided in this form will be used by the court and by the persons and agencies designated by the court to assist the court in determining whether to appoint the proposed conservator as conservator. The proposed conservator must respond to each item.

1. a. Proposed conservator (name): b. Date of birth: c. Social security number: d. Driver's license number: State: e. Telephone numbers: Home: Work: Other:
2. a. [] 1! am related to the proposed conservatee as (specify relationship): b. [-] Ihave personally known the proposed conservatee for: years, months.
3. ([-] |was ["] 1} was not nominated as conservator of the [__] person [—] estate of the proposed conservatee, by [] the proposed conservatee. [—_] the spouse or registered domestic partner of the proposed conservatee. a parent of the proposed conservatee. : (If you checked ! 5 1 25 1 1 12 885 1398 44 15 67.562027 was,” 5 1 25 1 1 13 947 1394 78 21 96.734367 provide 5 1 25 1 1 14 1034 1394 155 17 96.734367 documentation 5 1 25 1 1 15 1197 1394 16 17 96.121323 in 5 1 25 1 1 16 1221 1394 120 17 96.121323 Attachment 5 1 25 1 1 17 1349 1394 24 22 96.939484 3.) 4 1 25 1 2 0 160 1435 1323 26 -1 5 1 25 1 2 1 160 1439 17 16 93.844284 4. 5 1 25 1 2 2 201 1443 17 13 93.166939 a. 5 1 25 1 2 3 241 1438 27 2 0.000000 [-] 5 1 25 1 2 4 304 1440 43 17 69.084564 lam 5 1 25 1 2 5 356 1440 33 17 95.916862 the 5 1 25 1 2 6 397 1444 76 17 96.436241 spouse 5 1 25 1 2 7 481 1439 20 17 96.436241 of 5 1 25 1 2 8 508 1439 32 17 96.925423 the 5 1 25 1 2 9 549 1439 99 22 93.292175 proposed 5 1 25 1 2 10 657 1440 136 16 92.397896 conservatee. 5 1 25 1 2 11 856 1435 50 25 13.336382 [2] 5 1 25 1 2 12 923 1437 62 17 12.421265 |have 5 1 25 1 2 13 1014 1435 49 24 18.697062 [7] 5 1 25 1 2 14 1081 1437 102 17 54.669792 Ihavenot 5 1 25 1 2 15 1231 1437 41 17 55.777748 filed 5 1 25 1 2 16 1281 1437 26 17 96.726601 for 5 1 25 1 2 17 1315 1437 47 22 96.726601 legal 5 1 25 1 2 18 1371 1437 112 22 96.489014 separation, 2 1 26 0 0 0 304 1477 1080 52 -1 3 1 26 1 0 0 304 1477 1080 52 -1 4 1 26 1 1 0 304 1477 1080 23 -1 5 1 26 1 1 1 304 1479 112 17 96.043900 dissolution 5 1 26 1 1 2 425 1479 19 16 96.853928 of 5 1 26 1 1 3 452 1483 99 17 96.094994 marriage, 5 1 26 1 1 4 561 1478 116 19 95.893898 annulment, 5 1 26 1 1 5 687 1482 21 13 96.990562 or 5 1 26 1 1 6 716 1477 127 22 96.922012 adjudication 5 1 26 1 1 7 853 1477 19 16 96.371414 of 5 1 26 1 1 8 881 1477 58 21 96.371414 nullity 5 1 26 1 1 9 947 1477 19 16 96.879959 of 5 1 26 1 1 10 974 1477 32 16 96.986176 the 5 1 26 1 1 11 1015 1477 98 21 81.815033 marriage. 5 1 26 1 1 12 1130 1477 21 21 35.703110 (If 5 1 26 1 1 13 1162 1481 32 18 96.885490 you 5 1 26 1 1 14 1202 1477 88 17 93.266228 checked 5 1 26 1 1 15 1299 1477 11 17 76.491661 ! have," explain in Attachment 4.) b. __] | am not the spouse of the proposed conservatee a iy

• _| | am the registered domestic partner of the proposed conservatee. Idonot [__] !do _ intend to terminate my domestic partnership with the proposed conservatee. (If you checked ! 5 1 29 1 2 13 1222 1623 41 20 81.339127 do,” 5 1 29 1 2 14 1270 1623 73 21 94.302109 explain 5 1 29 1 2 15 1351 1623 16 16 94.302109 in 5 1 29 1 2 16 1375 1623 118 17 96.856850 Attachment 5 1 29 1 2 17 1501 1622 24 22 96.569908 5.) 3 1 29 2 0 0 201 1668 1218 23 -1 4 1 29 2 1 0 201 1668 1218 23 -1 5 1 29 2 1 1 201 1669 11 17 92.836266 b 5 1 29 2 1 2 254 1668 28 1 15.156994 ~~] 5 1 29 2 1 3 305 1671 43 16 38.118763 1am 5 1 29 2 1 4 357 1675 11 12 92.388573 a 5 1 29 2 1 5 377 1670 68 17 96.101555 former 5 1 29 2 1 6 454 1670 95 17 96.369675 domestic 5 1 29 2 1 7 558 1671 75 20 96.711624 partner 5 1 29 2 1 8 641 1669 20 17 96.999458 of 5 1 29 2 1 9 668 1670 32 16 96.806107 the 5 1 29 2 1 10 709 1669 99 21 93.292328 proposed 5 1 29 2 1 11 817 1669 135 16 92.105263 conservatee. 5 1 29 2 1 12 969 1668 30 21 96.572403 My 5 1 29 2 1 13 1008 1669 93 16 96.639046 domestic 5 1 29 2 1 14 1111 1669 116 20 96.809105 partnership 5 1 29 2 1 15 1235 1669 40 16 96.400269 with 5 1 29 2 1 16 1284 1669 31 16 96.532135 the 5 1 29 2 1 17 1324 1669 95 21 96.734940 proposed 3 1 29 3 0 0 303 1704 1184 23 -1 4 1 29 3 1 0 303 1704 1184 23 -1 5 1 29 3 1 1 303 1708 130 16 92.110474 conservatee 5 1 29 3 1 2 441 1711 41 13 96.836914 was 5 1 29 3 1 3 491 1707 112 16 96.539772 terminated 5 1 29 3 1 4 613 1711 24 12 96.874626 on 5 1 29 3 1 5 648 1706 67 21 96.463310 (date): 5 1 29 3 1 6 1063 1704 83 21 96.318649 (Explain 5 1 29 3 1 7 1155 1705 150 16 96.318649 circumstances 5 1 29 3 1 8 1313 1705 16 16 96.390045 in 5 1 29 3 1 9 1337 1705 118 16 96.469475 Attachment 5 1 29 3 1 10 1463 1704 24 21 96.926712 5.) 2 1 30 0 0 0 201 1743 947 22 -1 3 1 30 1 0 0 201 1743 947 22 -1 4 1 30 1 1 0 201 1743 947 22 -1 5 1 30 1 1 1 201 1751 15 12 43.512772 c. 5 1 30 1 1 2 304 1746 2 16 79.049248 | 5 1 30 1 1 3 316 1750 31 12 79.049248 am 5 1 30 1 1 4 357 1745 72 17

  circumstances 5 1 29 3 1 8 1313 1705 16 16 96.390045 in 5 1 29 3 1 9 1337 1705 118 16 96.469475 Attachment 5 1 29 3 1 10 1463 1704 24 21 96.926712 5.) 2 1 30 0 0 0 201 1743 947 22 -1 3 1 30 1 0 0 201 1743 947 22 -1 4 1 30 1 1 0 201 1743 947 22 -1 5 1 30 1 1 1 201 1751 15 12 43.512772 c. 5 1 30 1 1 2 304 1746 2 16 79.049248 | 5 1 30 1 1 3 316 1750 31 12 79.049248 am 5 1 30 1 1 4 357 1745 72 17 96.649605 neither 5 1 30 1 1 5 437 1749 11 13 95.641884 a 5 1 30 1 1 6 457 1746 73 16 95.641884 current 5 1 30 1 1 7 539 1749 34 12 96.856956 nor 5 1 30 1 1 8 581 1745 69 16 96.648575 former 5 1 30 1 1 9 659 1745 95 16 96.130020 domestic 5 1 30 1 1 10 763 1745 75 20 96.744873 partner 5 1 30 1 1 11 846 1743 19 17 96.976196 of 5 1 30 1 1 12 874 1743 31 16 96.261497 the 5 1 30 1 1 13 914 1743 97 21 93.287277 proposed 5 1 30 1 1 14 1021 1745 127 15 79.138451 conservatee 2 1 31 0 0 0 1091 1997 404 1 -1 3 1 31 1 0 0 1091 1997 404 1 -1 4 1 31 1 1 0 1091 1997 404 1 -1 5 1 31 1 1 1 1091 1997 404 1 95.000000 2 1 32 0 0 0 157 1789 1438 267 -1 3 1 32 1 0 0 157 1789 1438 267 -1 4 1 32 1 1 0 160 1789 1169 26 -1 5 1 32 1 1 1 160 1792 10 16 92.507713 6. 5 1 32 1 1 2 201 1795 10 13 77.618256 a 5 1 32 1 1 3 237 1789 51 26 0.000000 [_~] 5 1 32 1 1 4 304 1793 37 16 87.364899 Ido 5 1 32 1 1 5 404 1790 14 1 35.336792 __] 5 1 32 1 1 6 449 1793 2 16 13.222837 1 5 1 32 1 1 7 461 1793 25 16 13.222837 do 5 1 32 1 1 8 495 1793 32 16 88.622841 not 5 1 32 1 1 9 579 1796 42 13 96.665901 owe 5 1 32 1 1 10 631 1796 70 17 96.615730 money 5 1 32 1 1 11 709 1796 20 12 96.129456 or 5 1 32 1 1 12 739 1792 50 16 96.681793 have 5 1 32 1 1 13 797 1795 11 12 96.505569 a 5 1 32 1 1 14 818 1791 86 16 96.442314 financial 5 1 32 1 1 15 913 1791 100 21 96.457916 obligation 5 1 32 1 1 16 1023 1792 17 15 96.978012 to 5 1 32 1 1 17 1049 1791 31 16 96.441093 the 5 1 32 1 1 18 1090 1791 96 20 93.232185 proposed 5 1 32 1 1 19 1195 1792 134 16 92.144516 conservatee. 4 1 32 1 2 0 242 1817 505 27 -1 5 1 32 1 2 1 242 1823 20 20 80.733620 (If 5 1 32 1 2 2 268 1827 39 17 96.291420 you 5 1 32 1 2 3 315 1823 90 16 96.291420 checked do,” explain in Attachment 6.) b. The proposed conservatee _} does | ] does not owe money or have a financial obligation to me (If you checked “does,” explain in Attachment 6.) c. [Jlam (__] lamnot an agent for a creditor of the proposed conservatee If you checked | 5 1 32 1 6 5 426 1967 48 19 92.280289 am,” 5 1 32 1 6 6 481 1966 75 21 96.278580 explain 5 1 32 1 6 7 565 1971 16 11 95.603088 in 5 1 32 1 6 8 589 1966 122 33 49.224529 Attachment 5 1 32 1 6 9 721 1961 24 29 95.258072 6.) 5 1 32 1 6 10 754 1997 77 1 0.000000 — 5 1 32 1 6 11 1518 1979 34 13 94.480927 Page 5 1 32 1 6 12 1559 1979 4 9 70.328156 1 5 1 32 1 6 13 1571 1978 24 11 70.328156 of 5 1 32 1 6 14 1592 1960 6 36 95.960159 2 4 1 32 1 7 0 157 1997 1431 26 -1 5 1 32 1 7 1 157 1999 43 16 88.568001 “Form 5 1 32 1 7 2 207 1999 58 18 87.630051 Adopted 5 1 32 1 7 3 272 2005 16 11 94.158585 for 5 1 32 1 7 4 295 1999 108 20 94.037331 Mandatory 5 1 32 1 7 5 442 1999 5 1 77.650131 Use 5 1 32 1 7 6 553 1997 199 26 92.295792 CONFIDENTIAL 5 1 32 1 7 7 761 2003 206 18 92.402725 CONSERVATOR 5 1 32 1 7 8 978 2003 154 18 95.838837 SCREENING 5 1 32 1 7 9 1143 1997 74 24 95.838837 FORM 5 1 32 1 7 10 1387 1997 53 17 84.170967 Provate 5 1 32 1 7 11 1446 2003 36 11 92.068321 Cade. 5 1 32 1 7 12 1493 2003 15 14 85.845589 §§ 5 1 32 1 7 13 1516 2003 31 10 94.727295 1810. 5 1 32 1 7 14 1559 2003 29 10 93.202942 1811 4 1 32 1 8 0 183 2021 1408 16 -1 5 1 32 1 8 1 183 2023 52 11 90.702194 Judiciat 5 1 32 1 8 2 246 2023 47 12 75.205681 Council 5 1 32 1 8 3 300 2023 11 11 93.303352 of 5 1 32 1 8 4 317 2023 66 12 32.254303 Caltornia 5 1 32 1 8 5 802 2035 3 2 23.390083 . 5 1 32 1 8 6 867 2034 2 2 61.275627 . 5 1 32 1 8 7 1125 2034 3 2 11.869535 a 5 1 32 1 8 8 1515 2021 32 11 95.738068 2104, 5 1 32 1 8 9 1558 2021 33 11 95.056328 2346: 4 1 32 1 9 0 187 2033 1408 23 -1 5 1 32 1 9 1 187 2041 54 12 92.246033 GC-314 5 1 32 1 9 2 249 2042 30 11 47.603756 [Rev. 5 1 32 1 9 3 290 2043 39 13 96.754509 July 5 1 32 1 9 4 325 2033 12 28 88.429321 1, 5 1 32 1 9 5 341 2042 38 13 92.466331 2009] 5 1 32 1 9 6 607 2034 291 21 68.297905 {Probate—Guardianships 5 1 32 1 9 7 908 2034 38 15 93.052094 and 5 1 32 1 9 8 956 2033 207 22 92.555992 Conservatorships) 5 1 32 1 9 9 1377 2041 22 10 67.171173 Cal 5 1 32 1 9 10 1411 2041 36 10 86.076675 Rules 5 1 32 1 9 11 1454 2040 11 11 96.968681 of 5 1 32 1 9 12 1475 2031 33 28 86.960228 Coun, 5 1 32 1 9 13 1519 2041 24 10 85.796333 rule 5 1 32 1 9 14 1550 2040 45 11 92.588913 7.1050 2 1 33 0 0 0 1596 240 4 828 -1 3 1 33 1 0 0 1596 240 4 828 -1 4 1 33 1 1 0 1596 240 4 828 -1 5 1 33 1 1 1 1596 240 4 828 95.000000 2 1 34 0 0 0 1467 2060 128 10 -1 3 1 34 1 0 0 1467 2060 128 10 -1 4 1 34 1 1 0 1467 2060 128 10 -1 5 1 34 1 1 1 1467 2062 32 7 58.935631 www. 5 1 34 1 1 2 1505 2060 61 9 58.935631 courls.ca 5 1 34 1 1 3 1572 2061 23 9 86.119820 gov

_ CONFIDENTIAL __ GC-314 CONSERVATORSHIP OF (Name): CASE NUMBER: PROPOSED CONSERVATEE 7. [-] ihave [J Ihave not filed for bankruptcy protection within the last 10 years. (if you checked ! 5 1 9 1 1 20 1291 335 69 20 78.511024 have, explain in Attachment 7.) 8. [ Ihave [] |havenot been convicted of a felony or had a felony expunged from my record. (/f you checked ! 5 1 10 1 1 23 1453 403 69 20 92.485802 have,” 4 1 10 1 2 0 527 425 258 23 -1 5 1 10 1 2 1 527 425 73 20 95.153198 explain 5 1 10 1 2 2 609 425 17 16 95.153198 in 5 1 10 1 2 3 635 425 118 18 96.204376 Attachment 5 1 10 1 2 4 761 426 24 22 90.900581 8.) 2 1 11 0 0 0 130 459 1323 68 -1 3 1 11 1 0 0 130 459 1323 62 -1 4 1 11 1 1 0 130 459 1323 34 -1 5 1 11 1 1 1 130 461 17 18 90.053719 9. 5 1 11 1 1 2 176 459 49 26 0.000000 [] 5 1 11 1 1 3 243 463 61 17 43.854710 Ihave 5 1 11 1 1 4 325 461 48 27 47.377747 [] 5 1 11 1 1 5 391 465 60 18 58.902351 Ihave 5 1 11 1 1 6 460 469 31 15 74.911217 not 5 1 11 1 1 7 527 465 50 18 47.272804 been 5 1 11 1 1 8 585 467 84 22 96.396683 charged 5 1 11 1 1 9 677 468 48 21 96.673897 with, 5 1 11 1 1 10 734 469 84 16 96.207336 arrested 5 1 11 1 1 11 826 468 32 21 96.986938 for, 5 1 11 1 1 12 867 473 20 13 96.597755 or 5 1 11 1 1 13 895 469 98 18 96.805443 convicted 5 1 11 1 1 14 1001 469 21 19 96.838211 of 5 1 11 1 1 15 1029 470 159 21 91.979408 embezzlement, 5 1 11 1 1 16 1197 471 50 20 95.090080 theft, 5 1 11 1 1 17 1257 476 20 13 96.595665 or 5 1 11 1 1 18 1286 476 37 17 97.011391 any 5 1 11 1 1 19 1331 472 55 17 95.509254 other 5 1 11 1 1 20 1395 477 58 12 81.595436 crime 4 1 11 1 2 0 527 494 858 27 -1 5 1 11 1 2 1 527 494 76 17 96.252464 involving 5 1 11 1 2 2 625 496 32 17 96.981491 the 5 1 11 1 2 3 665 496 48 17 96.822952 taking 5 1 11 1 2 4 735 496 19 17 96.358665 of 5 1 11 1 2 5 762 499 89 19 80.906395 property. 5 1 11 1 2 6 876 497 14 17 79.322159 (if 5 1 11 1 2 7 895 502 38 17 96.633469 you 5 1 11 1 2 8 940 498 90 17 93.291321 checked 5 1 11 1 2 9 1038 498 13 17 75.032616 ! have,” explain in Attachment 9. ig IG 'y 10. Ihave [] thavenot been charged with, arrested for, or convicted of a crime involving fraud, conspiracy, or misrepresentation of information. (If you checked ! 5 1 12 1 2 8 1074 569 69 21 84.977898 have,” 5 1 12 1 2 9 1149 569 74 22 95.395821 explain 5 1 12 1 2 10 1229 569 19 18 95.395821 in 5 1 12 1 2 11 1254 570 125 18 96.316002 Attachment 5 1 12 1 2 12 1389 571 28 18 96.679764 10. 5 1 12 1 2 13 1419 571 7 22 92.015564 ) 2 1 13 0 0 0 135 603 1263 33 -1 3 1 13 1 0 0 135 603 1263 33 -1 4 1 13 1 1 0 135 603 1263 33 -1 5 1 13 1 1 1 135 614 23 5 50.095898 14. 5 1 13 1 1 2 222 614 2 11 54.944046 | 5 1 13 1 1 3 254 606 49 17 86.473938 thave 5 1 13 1 1 4 323 603 50 25 50.047447 [__] 5 1 13 1 1 5 389 607 101 18 7.002268 ihavenot 5 1 13 1 1 6 526 608 50 17 73.743553 been 5 1 13 1 1 7 585 609 84 22 95.760033 charged 5 1 13 1 1 8 677 610 47 20 96.082092 with, 5 1 13 1 1 9 733 611 85 17 94.961830 arrested 5 1 13 1 1 10 825 611 32 20 95.194572 for, 5 1 13 1 1 11 867 616 20 12 95.194572 or 5 1 13 1 1 12 895 612 98 17 96.434921 convicted 5 1 13 1 1 13 1001 612 21 17 96.937729 of 5 1 13 1 1 14 1029 617 37 18 96.459312 any 5 1 13 1 1 15 1073 612 46 18 96.798378 form 5 1 13 1 1 16 1127 613 20 17 96.645683 of 5 1 13 1 1 17 1155 615 52 16 96.943573 elder 5 1 13 1 1 18 1215 615 63 16 96.012367 abuse 5 1 13 1 1 19 1286 619 21 12 96.012367 or 5 1 13 1 1 20 1315 615 83 21 96.479744 neglect. 2 1 14 0 0 0 527 637 534 26 -1 3 1 14 1 0 0 527 637 534 26 -1 4 1 14 1 1 0 527 637 534 26 -1 5 1 14 1 1 1 527 637 21 21 96.189682 (if 5 1 14 1 1 2 551 641 39 18 95.827232 you 5 1 14 1 1 3 598 638 89 17 95.827232 checked have," explain in Attachment 11.) 12. [7] Ihave [] thave not _ had a restraining order or protective order filed against me in the last 10 years. (if you checked I 5 1 15 1 2 5 715 705 67 21 91.952209 have,” 5 1 15 1 2 6 788 706 73 22 96.532280 explain 5 1 15 1 2 7 868 706 19 18 93.262634 in 5 1 15 1 2 8 893 707 122 18 82.165810 Atlachment 5 1 15 1 2 9 1024 707 37 23 93.689011 12.) 2 1 16 0 0 0 129 737 1224 64 -1 3 1 16 1 0 0 129 737 1224 64 -1 4 1 16 1 1 0 129 737 1224 36 -1 5 1 16 1 1 1 129 742 28 17 93.145767 13. 5 1 16 1 1 2 174 739 49 26 0.000000 [7] 5 1 16 1 1 3 240 745 62 17 81.130829 Ihave 5 1 16 1 1 4 332 742 27 2 26.795887 [7] 5 1 16 1 1 5 389 747 61 17 83.616402 Ihave 5 1 16 1 1 6 459 749 31 16 81.819115 not 5 1 16 1 1 7 525 747 86 21 47.619545 required 5 1 16 1 1 8 619 749 18 16 96.970116 to 5 1 16 1 1 9 646 748 78 22 96.951584 register 5 1 16 1 1 10 731 737 24 29 96.524612 as 5 1 16 1 1 11 763 753 12 13 94.945107 a 5 1 16 1 1 12 782 753 36 14 94.669563 sex 5 1 16 1 1 13 825 749 87 18 84.070396 offender 5 1 16 1 1 14 920 739 59 28 94.803604 under 5 1 16 1 1 15 987 750 99 19 96.614067 California 5 1 16 1 1 16 1095 751 58 18 97.003288 Penal 5 1 16 1 1 17 1167 745 45 33 96.961510 Code 5 1 16 1 1 18 1222 745 78 33 96.961510 section 5 1 16 1 1 19 1309 753 44 17 96.845520 290. 4 1 16 1 2 0 489 775 554 26 -1 5 1 16 1 2 1 489 780 3 4 12.825556 * 5 1 16 1 2 2 526 775 21 22 24.360809 (if 5 1 16 1 2 3 551 780 38 17 94.913445 you 5 1 16 1 2 4 597 776 90 17 96.187080 checked 5 1 16 1 2 5 695 777 12 17 47.486053 | am,” explain in Attachment 13.) 14. [_] Ihave !have not previously been appointed conservator, executor, or fiduciary in another proceeding. (If you checked I 5 1 17 1 2 5 714 847 67 20 89.098457 have,” 5 1 17 1 2 6 787 847 74 22 94.086136 explain 5 1 17 1 2 7 868 847 18 18 96.636131 in 5 1 17 1 2 8 893 848 121 19 96.180489 Attachment 5 1 17 1 2 9 1023 849 38 22 93.873833 14.) 2 1 18 0 0 0 128 880 1395 59 -1 3 1 18 1 0 0 128 880 1395 59 -1 4 1 18 1 1 0 128 880 1395 33 -1 5 1 18 1 1 1 128 880 29 17 81.705582 15, 5 1 18 1 1 2 239 883 62 20 76.960899 thave 5 1 18 1 1 3 330 905 8 1 63.973553 [ 5 1 18 1 1 4 387 885 62 18 38.572048 Ihave 5 1 18 1 1 5 457 887 32 16 61.812828 not 5 1 18 1 1 6 525 885 49 16 67.946571 been 5 1 18 1 1 7 583

1 2 9 1023 849 38 22 93.873833 14.) 2 1 18 0 0 0 128 880 1395 59 -1 3 1 18 1 0 0 128 880 1395 59 -1 4 1 18 1 1 0 128 880 1395 33 -1 5 1 18 1 1 1 128 880 29 17 81.705582 15, 5 1 18 1 1 2 239 883 62 20 76.960899 thave 5 1 18 1 1 3 330 905 8 1 63.973553 [_ 5 1 18 1 1 4 387 885 62 18 38.572048 Ihave 5 1 18 1 1 5 457 887 32 16 61.812828 not 5 1 18 1 1 6 525 885 49 16 67.946571 been 5 1 18 1 1 7 583 886 91 17 96.830673 removed 5 1 18 1 1 8 683 891 20 12 96.503159 or 5 1 18 1 1 9 711 887 89 22 96.503159 resigned 5 1 18 1 1 10 808 892 23 12 96.867523 as 5 1 18 1 1 11 839 892 12 13 94.818161 a 5 1 18 1 1 12 859 889 128 20 94.818161 conservator, 5 1 18 1 1 13 997 889 97 22 96.854836 guardian, 5 1 18 1 1 14 1104 891 95 18 96.001999 executor, 5 1 18 1 1 15 1208 895 21 12 96.001999 or 5 1 18 1 1 16 1235 890 90 22 95.291824 fiduciary 5 1 18 1 1 17 1333 891 17 16 96.898872 in 5 1 18 1 1 18 1359 895 38 18 96.767624 any 5 1 18 1 1 19 1405 892 54 16 96.607956 other 5 1 18 1 1 20 1468 897 55 12 96.468964 case. 4 1 18 1 2 0 525 913 535 26 -1 5 1 18 1 2 1 525 913 21 21 89.705009 (if 5 1 18 1 2 2 550 918 38 17 96.090836 you 5 1 18 1 2 3 597 914 89 17 93.249832 checked 5 1 18 1 2 4 694 915 12 16 23.796778 ! have," explain in Attachment 15.) 16. ["] I have or may have 1do not have an adverse interest that the court may consider to be a risk to, or to have an effect on, my ability to faithfully perform the duties of conservator. (If you checked } 5 1 19 1 2 16 1411 989 51 18 96.689171 have 5 1 19 1 2 17 1471 995 22 12 96.689171 or 4 1 19 1 3 0 523 1011 398 25 -1 5 1 19 1 3 1 523 1015 44 17 96.928406 may 5 1 19 1 3 2 574 1011 69 21 91.792267 have,” 5 1 19 1 3 3 649 1013 74 21 95.864555 explain 5 1 19 1 3 4 731 1013 16 16 96.330177 in 5 1 19 1 3 5 755 1013 120 18 19.361811 Attachment 5 1 19 1 3 6 884 1014 37 22 96.173798 16.) 2 1 20 0 0 0 127 1045 1380 64 -1 3 1 20 1 0 0 127 1045 1380 64 -1 4 1 20 1 1 0 127 1045 1380 36 -1 5 1 20 1 1 1 127 1048 28 17 0.000000 17. 5 1 20 1 1 2 171 1045 50 26 0.000000 [J 5 1 20 1 1 3 238 1049 43 17 14.322424 tam 5 1 20 1 1 4 321 1047 49 25 0.000000 [] 5 1 20 1 1 5 388 1051 83 17 59.494881 lamnot 5 1 20 1 1 6 523 1056 12 12 96.856705 a 5 1 20 1 1 7 543 1052 70 21 96.621376 private 5 1 20 1 1 8 621 1053 126 20 96.539284 professional 5 1 20 1 1 9 755 1053 92 23 95.296425 fiduciary, 5 1 20 1 1 10 857 1059 24 13 96.715469 as 5 1 20 1 1 11 889 1055 76 18 96.352898 defined 5 1 20 1 1 12 974 1055 17 18 96.352898 in 5 1 20 1 1 13 999 1056 95 17 96.042717 Business 5 1 20 1 1 14 1103 1057 37 16 97.003937 and 5 1 20 1 1 15 1150 1057 121 17 96.656242 Professions 5 1 20 1 1 16 1281 1057 56 18 96.995018 Code 5 1 20 1 1 17 1345 1059 76 16 93.289398 section 5 1 20 1 1 18 1431 1059 76 22 92.228531 6501(f) 4 1 20 1 2 0 524 1080 891 29 -1 5 1 20 1 2 1 524 1080 21 21 45.240532 (if 5 1 20 1 2 2 549 1085 38 16 96.467445 you 5 1 20 1 2 3 595 1081 90 17 92.243843 checked 5 1 20 1 2 4 693 1082 12 17 35.017838 ! am," respond to item 18. If you checked I 5 1 20 1 2 14 1167 1089 32 13 96.077980 am 5 1 20 1 2 15 1206 1085 49 21 96.294113 not,” 5 1 20 1 2 16 1261 1090 26 17 96.762924 go 5 1 20 1 2 17 1296 1087 18 16 96.100273 to 5 1 20 1 2 18 1322 1087 45 16 91.209206 item 5 1 20 1 2 19 1378 1087 37 22 40.065762 19.) 2 1 21 0 0 0 127 1121 1393 210 -1 3 1 21 1 0 0 127 1121 1393 176 -1 4 1 21 1 1 0 127 1121 1339 32 -1 5 1 21 1 1 1 127 1121 28 18 86.125160 18. 5 1 21 1 1 2 171 1125 2 17 75.882118 [ 5 1 21 1 1 3 218 1125 63 17 45.352650 }tam 5 1 21 1 1 4 320 1121 50 25 62.326439 [7] 5 1 21 1 1 5 388 1125 43 17 46.264034 tam 5 1 21 1 1 6 440 1127 31 15 46.264034 not 5 1 21 1 1 7 523 1127 89 22 96.235176 currently 5 1 21 1 1 8 621 1127 85 18 96.786674 licensed 5 1 21 1 1 9 715 1129 24 21 96.923019 by 5 1 21 1 1 10 746 1129 32 17 95.924088 the 5 1 21 1 1 11 787 1129 128 18 93.295723 Professional 5 1 21 1 1 12 925 1130 112 18 92.642029 Fiduciaries 5 1 21 1 1 13 1047 1131 72 18 97.001961 Bureau 5 1 21 1 1 14 1128 1131 20 18 96.957741 of 5 1 21 1 1 15 1155 1132 32 17 96.930054 the 5 1 21 1 1 16 1196 1132 123 21 96.547089 Department 5 1 21 1 1 17 1328 1133 19 16 96.666000 of 5 1 21 1 1 18 1355 1133 111 18 96.666000 Consumer 4 1 21 1 2 0 522 1155 946 26 -1 5 1 21 1 2 1 522 1155 71 16 96.603462 Affairs. 5 1 21 1 2 2 603 1155 30 22 96.545403 My 5 1 21 1 2 3 642 1156 72 17 96.545403 license 5 1 21 1 2 4 722 1157 61 17 96.986084 status 5 1 21 1 2 5 793 1157 36 18 95.241623 and 5 1 21 1 2 6 839 1157 115 18 95.241623 information 5 1 21 1 2 7 963 1158 15 17 96.920547 is 5 1 21 1 2 8 987 1159 64 17 96.473244 stated 5 1 21 1 2 9 1059 1159 16 17 96.223457 in 5 1 21 1 2 10 1084 1159 43 17 96.149139 item 5 1 21 1 2 11 1136 1160 7 16 82.621208 1 5 1 21 1 2 12 1155 1164 24 13 92.116776 on 5 1 21 1 2 13 1189 1164 51 17 94.488983 page 5 1 21 1 2 14 1249 1161 7 16 93.150055 1 5 1 21 1 2 15 1268 1160 20 17 93.150055 of 5 1 21 1 2 16 1295 1161 33 16 96.744011 the 5 1 21 1 2 17 1337 1161 131 18 96.809006 Professional 4 1 21 1 3 0 523 1183 997 28 -1 5 1 21 1 3 1 523 1183 94 22 96.903702 Fiduciary 5 1 21 1 3 2 625 1184 120 18 96.459297 Attachment 5 1 21 1 3 3 753 1185 67 22 96.803772 signed 5 1 21 1 3 4 829 1185 24 22 96.984047 by 5 1 21 1 3 5 861 1191 32 12 95.975403 me 5 1 21 1 3 6 901 1187 37 16 95.975403 and 5 1 21 1 3 7 947 1187 90 17 96.979393 attached 5 1 21 1 3 8 1045 1188 18 16 96.394394 to 5 1 21 1 3 9 1072 1187 31 18 96.394394 the 5 1 21 1 3 10 1112 1187 74 22 96.915222 petition 5 1 21 1 3 11 1195 1188 38 17 96.949913 that 5 1 21 1 3 12 1242 1193 97 17 96.787300 proposes 5 1 21 1 3 13 1349 1194 30 17 96.838814 my 5 1 21 1 3 14 1388 1190 132 21 96.129211 appointment 4 1 21 1 4 0 522 1213 980 26 -1 5 1 21 1 4 1 522 1215 23 13 96.101517 as 5 1 21 1 4 2 553 1213 124 16 94.289955 conservator 5 1 21 1 4 3 686 1213 15 16 93.491112 in 5 1 21 1 4 4 710 1213 35 17 93.491112 this 5 1 21 1 4 5 755 1215 70 16 96.382423 matter. 5 1 21 1 4 6 835 1213 108 23 96.652847 (Complete 5 1 21 1 4 7 951 1215 40 17 96.862732 and 5 1 21 1 4 8 99

1388 1190 132 21 96.129211 appointment 4 1 21 1 4 0 522 1213 980 26 -1 5 1 21 1 4 1 522 1215 23 13 96.101517 as 5 1 21 1 4 2 553 1213 124 16 94.289955 conservator 5 1 21 1 4 3 686 1213 15 16 93.491112 in 5 1 21 1 4 4 710 1213 35 17 93.491112 this 5 1 21 1 4 5 755 1215 70 16 96.382423 matter. 5 1 21 1 4 6 835 1213 108 23 96.652847 (Complete 5 1 21 1 4 7 951 1215 40 17 96.862732 and 5 1 21 1 4 8 997 1215 43 22 96.326401 sign 5 1 21 1 4 9 1049 1216 30 17 96.804672 the 5 1 21 1 4 10 1088 1216 131 17 96.988350 Professional 5 1 21 1 4 11 1226 1217 98 22 96.520462 Fiduciary 5 1 21 1 4 12 1330 1218 123 17 96.588753 Attachment 5 1 21 1 4 13 1461 1219 41 16 96.588753 and 4 1 21 1 5 0 522 1240 980 27 -1 5 1 21 1 5 1 522 1240 63 16 90.746544 aitach 5 1 21 1 5 2 592 1241 12 16 96.581589 it 5 1 21 1 5 3 613 1241 17 16 96.899109 to 5 1 21 1 5 4 639 1241 31 16 96.836449 the 5 1 21 1 5 5 677 1241 82 21 94.081657 petition, 5 1 21 1 5 6 768 1246 22 13 96.919777 or 5 1 21 1 5 7 797 1242 70 17 96.832420 deliver 5 1 21 1 5 8 872 1242 11 18 96.269836 it 5 1 21 1 5 9 891 1244 18 16 96.269836 to 5 1 21 1 5 10 919 1243 30 17 95.605225 the 5 1 21 1 5 11 955 1243 102 22 95.986427 petitioner 5 1 21 1 5 12 1063 1244 28 17 96.596085 for 5 1 21 1 5 13 1097 1245 121 20 96.902435 attachment, 5 1 21 1 5 14 1228 1245 67 17 95.899460 before 5 1 21 1 5 15 1304 1245 32 18 96.801117 the 5 1 21 1 5 16 1343 1247 78 20 96.935493 petition 5 1 21 1 5 17 1430 1247 16 16 96.951759 is 5 1 21 1 5 18 1454 1247 48 17 96.654953 filed. 4 1 21 1 6 0 523 1267 954 30 -1 5 1 21 1 6 1 523 1267 38 17 96.827766 See 5 1 21 1 6 2 570 1269 45 16 65.097359 iter 5 1 21 1 6 3 623 1269 52 22 89.130272 3c(7) 5 1 21 1 6 4 684 1269 21 17 96.086075 of 5 1 21 1 6 5 711 1270 30 17 95.481178 the 5 1 21 1 6 6 749 1270 80 21 95.343552 petition. 5 1 21 1 6 7 841 1271 39 17 96.955086 Use 5 1 21 1 6 8 888 1271 47 17 96.955086 form 5 1 21 1 6 9 944 1271 311 24 91.117699 GC-210(A-PF)/GC-310(A-PF) 5 1 21 1 6 10 1263 1273 30 18 96.759628 for 5 1 21 1 6 11 1299 1274 37 17 95.905373 this 5 1 21 1 6 12 1343 1275 134 22 94.932396 attachment.) 3 1 21 2 0 0 1289 1319 11 12 -1 4 1 21 2 1 0 1289 1319 11 12 -1 5 1 21 2 1 1 1289 1319 11 12 54.281822 }- 2 1 22 0 0 0 1281 1332 17 9 -1 3 1 22 1 0 0 1281 1332 17 9 -1 4 1 22 1 1 0 1281 1332 17 9 -1 5 1 22 1 1 1 1281 1332 17 9 43.795959 1): 2 1 23 0 0 0 126 1307 1133 32 -1 3 1 23 1 0 0 126 1307 1133 32 -1 4 1 23 1 1 0 126 1307 1133 32 -1 5 1 23 1 1 1 126 1309 27 16 44.072304 19. 5 1 23 1 1 2 170 1307 49 25 39.019730 [J] 5 1 23 1 1 3 236 1311 43 16 37.679253 tam 5 1 23 1 1 4 302 1303 4 35 47.552418 = 5 1 23 1 1 5 319 1308 49 25 0.000000 [_] 5 1 23 1 1 6 387 1312 82 17 51.132843 lamnot 5 1 23 1 1 7 521 1317 12 12 96.112373 a 5 1 23 1 1 8 542 1314 120 17 96.136116 responsible 5 1 23 1 1 9 670 1316 99 20 96.522659 corporate 5 1 23 1 1 10 777 1315 64 18 96.994263 officer 5 1 23 1 1 11 848 1316 109 17 96.149025 authorized 5 1 23 1 1 12 965 1318 17 15 96.149025 to 5 1 23 1 1 13 993 1318 30 16 96.429459 act 5 1 23 1 1 14 1031 1317 28 16 96.251503 for 5 1 23 1 1 15 1067 1317 64 22 92.349792 (name 5 1 23 1 1 16 1140 1318 22 17 93.226410 of 5 1 23 1 1 17 1167 1319 92 20 75.801491 corporati 2 1 24 0 0 0 1259 1323 36 13 -1 3 1 24 1 0 0 1259 1323 36 13 -1 4 1 24 1 1 0 1259 1323 36 13 -1 5 1 24 1 1 1 1259 1323 36 13 95.000000
2 1 25 0 0 0 521 1387 983 142 -1 3 1 25 1 0 0 521 1387 983 142 -1 4 1 25 1 1 0 521 1387 966 28 -1 5 1 25 1 1 1 521 1391 11 12 96.605988 a 5 1 25 1 1 2 541 1387 99 18 96.098625 California 5 1 25 1 1 3 649 1389 91 21 96.493729 nonprofit 5 1 25 1 1 4 748 1390 101 17 96.493729 charitable 5 1 25 1 1 5 857 1391 117 21 96.928192 corporation 5 1 25 1 1 6 983 1391 39 18 96.985245 that 5 1 25 1 1 7 1031 1393 62 16 96.985168 meets 5 1 25 1 1 8 1101 1392 32 17 96.869133 the 5 1 25 1 1 9 1141 1393 137 21 96.034180 requirements 5 1 25 1 1 10 1288 1393 25 17 96.891861 for 5 1 25 1 1 11 1323 1395 132 20 95.772018 appointment 5 1 25 1 1 12 1464 1399 23 13 95.772018 as 4 1 25 1 2 0 521 1417 983 27 -1 5 1 25 1 2 1 521 1418 123 15 95.178978 conservator 5 1 25 1 2 2 652 1417 19 16 96.998901 of 5 1 25 1 2 3 678 1417 32 17 96.977455 the 5 1 25 1 2 4 719 1419 96 20 93.306213 proposed 5 1 25 1 2 5 824 1420 128 16 92.861786 conservatee 5 1 25 1 2 6 961 1420 60 17 96.399513 under 5 1 25 1 2 7 1029 1420 82 17 96.794998 Probate 5 1 25 1 2 8 1119 1421 55 17 95.769165 Code 5 1 25 1 2 9 1182 1421 73 17 96.630104 section 5 1 25 1 2 10 1264 1422 59 17 91.092987 2104. 5 1 25 1 2 11 1340 1422 3 16 91.092987 | 5 1 25 1 2 12 1353 1422 63 22 95.850525 certify 5 1 25 1 2 13 1425 1423 38 16 96.924080 that 5 1 25 1 2 14 1472 1424 32 16 96.949081 the 4 1 25 1 3 0 521 1444 920 27 -1 5 1 25 1 3 1 521 1444 134 20 70.759422 corporation's 5 1 25 1 3 2 663 1445 74 18 95.023323 articles 5 1 25 1 3 3 745 1445 20 18 95.503777 of 5 1 25 1 3 4 772 1446 135 21 96.401649 incorporation 5 1 25 1 3 5 916 1447 115 22 95.772194 specifically 5 1 25 1 3 6 1039 1448 96 17 95.772194 authorize 5 1 25 1 3 7 1143 1449 10 16 96.581543 it 5 1 25 1 3 8 1161 1450 18 16 96.754295 to 5 1 25 1 3 9 1188 1451 68 19 96.827568 accept 5 1 25 1 3 10 1265 1451 144 20 96.016441 appointments 5 1 25 1 3 11 1419 1455 22 12 96.579346 as 4 1 25 1 4 0 521 1473 967 26 -1 5 1 25 1 4 1 521 1474 128 16 90.429016 conservator. 5 1 25 1 4 2 673 1473 22 22 90.429016 (If 5 1 25 1 4 3 699 1479 38 16 96.842995 you 5 1 25 1 4 4 745 1475 88 16 93.266655 checked 5 1 25 1 4 5 842 1475 12 17 43.412811 ! am,” explain the circumstances of the corporation's care of, counseling of, or financial assistance to the proposed conservatee in Attachment 19. ) 20. Do you, or does any other person living in your home, have a social worker or parole or probation officer assigned to him or her? a Yes [] No (If you checked Yes, explain in Attachment 20 and provide the name, address, and telephone number of each social worker, parole officer, or probation officer. )

| declare under penalty of perjury under the laws

j@ that the foregoing is tru Date: (TYPE OR PRINT NAME OF PROPOSED CONSERVATOR) 7 (SIGNATURE OF PROPOSED CONSERVATOR) *Each proposed conservator must fill out and file a separate screening form. CONFIDENTIAL CONSERVATOR SCREENING FORM Page 2 ot2 (Probate—Guardianships and Conservatorships) GC-314 (Rev. July 1, 2009}

GC-348 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name. State Bar number. and address) FOR COURT USE ONLY TELEPHONE NO.: FAX NO. (Optional): £-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS street aooress: 801 10TH STREET, 4TH FLOOR manne avoress: 801 10TH STREET, 4TH FLOOR city anozp cove: MODESTO, CA 95354 BRANCH NAME: CONSERVATORSHIP OF THE [_] PERSON [-] ESTATE OF (Name): CONSERVATEE CASE NUMBER: DUTIES OF CONSERVATOR and Acknowledgment of Receipt of Handbook for Conservators DUTIES OF CONSERVATOR When you are appointed by the court as a conservator, you become responsible to the court and assume certain duties and obligations. All of your actions as conservator are subject to review by the court. You should clearly understand the information on this form. You will find additional information in the Judicial Council's Handbook for Conservators, receipt of which, in addition to a copy of this form, you are required by law to acknowledge. I. THE CONSERVATEE'S RIGHTS Conservatees do not lose all rights or all voice in important decisions affecting their lives. All conservatees have the right to be treated with understanding and respect, the right to have their wishes considered, and the right to be well cared for by their conservators. Conservatees generally keep the right to (1) control their own wages or salary from employment, (2) make or change a will, (3) marry, (4) receive personal mail, (5) be represented by a lawyer, (6) ask a judge to change conservators, (7) ask a judge to end the conservatorship, (8) vote, unless a judge decides they are not capable of exercising this right, (9) control personal spending money if a judge has authorized an allowance, and (10) make their own medical decisions, unless a judge has taken away that right and given it exclusively to their conservators. I. CONSULT WITH YOUR ATTORNEY Your attorney will advise you on your duties, the limits of your authority, the conservatee’s rights, your dealings with the court, all other topics discussed in this form, and many other matters. He or she will tell you when you must ask for prior court approval to take an action, when you may do so (and why it might be a good idea), and when prior court approval is not required. All Jegal questions should be discussed with your attomey, not the court staff, which is not permitted to give legal advice. Your attorney will] also help prepare your inventories, accountings, petitions, and all other documents to be filed with the court; and will see that the persons entitled to be notified of your actions are given proper notice. He or she will also advise you about legal limits on estate investments, Jeases and sales of estate assets, loans, lawsuits against others involving the conservatee or his or her property, and many other matters, and can prepare or review documents needed in these matters. You should communicate frequently and cooperate fully with your attorney at all times. When in doubt, contact your attorney. Other questions may be answered by calling on local community resources. (To find these resources, see the Handbook. for Conservators and the local supplement distributed by the court.) Il. CONSERVATOR OF THE PERSON If the court appoints you as conservator of the person, you are responsible for the conservatee’s care and protection. You must decide, within certain limits, where the conservatee will live; and you must arrange for the conservatee’s health care, meals, clothing, personal care, housekeeping, transportation, and recreation. A. DETERMINE THE APPROPRIATE LEVEL OF CARE FOR THE CONSERVATEE You must determine the conservatee’s appropriate level of care. Your determination must be in writing, signed under penalty of perjury, must be filed with the court within 60 days of the date of the court’s order appointing you as conservator, and must include: Page 1017 Form Adopted for Mandatory Us Probate Code. § 1&: Judicial Council of Callornia. DUTIES OF CONSERVATOR eve courts €2 gov GE-348 [Rev, January 1. 2031) and Acknowledgment of Receipt of Handbook for Conservators (Probate—Guardianships and Conservatorships)

GC-348 CONSERVATORSHIP OF (Name): a CASE NUMBER: CONSERVATEE. lil, A. 1. An evaluation of the level of care existing when the petition for your appointment as a conservator was filed and the measures that would be necessary to keep the conservatee in his or her personal residence. (Note: The conservaice's personai residence is the residence the conservatee understood or believed to be his or her permanent residence on (1) the date the petition for appointment of a conservator was filed in this matter, or (2) on the last earlier date the conservatee could form or communicate an understanding or belief about a permanent residence, whether or not he or she was living there when the appointment petition was filed. See Cal. Rules of Court, rule 7 1063(b).) 2. A plan to return the conservatee to his or her personal residence or an explanation of the limitations or restrictions on a return of the conservatee to that residence in the foreseeable future if the conservatee was not living there when the petition for appointment of a conservator was filed. 3. Arreevaluation after a material (important) change in circumstances affecting the conservatee’s needs for placement and care after your initial determination. 4. Ifthe conservatce is a limited conservatee who is developmentally disabled, special ruies may apply to the determination of his or her level of care and residential placement. See item VI below. B. DECIDE WHERE THE CONSERVATEE WILL LIVE

1. You must decide where the conservatee will live. You may choose a residence in Califomia without prior approval of the court, but you must choose the least restrictive appropriate residence that is available and necessary to meet the conservatee’s needs and that is in his or her best interests.
2. You must file a written notice of any change of the conservatee’s residence with the court within 30 days of the move, and you must mail copies of the notice to the conservatee’s attorney, the conservatee’s spouse or registered domestic partner, and the conservatee’s relatives who were mailed copies of the petition for your appointment as conservator, unless the court excuses you from the mailing to prevent harm to the conservatee. (There is a court form you must use for this notice and another form you may use to prove that you have mailed it. The forms are the Post-Move Notice of Change of Residence of Conservatee or Ward (form GC-080) and the Attachment to Post-Move Notice, etc. (form GC-080(MA). ‘These forms refer to a “post-move notice” because the notice may be filed and mailed after the date of the move.)
3. The law presumes that the conservatee’s personal residence (see item HIJA) is the conservatee’s Jeast restrictive appropriate residence. There must be a reason supported by sufficient evidence to justify a change of residence from the conservaiee’s personal residence (including a move from a care facility or other temporary placement to a residence that is not the conservatee’s personal residence).
4. If you want to move the conservatee from his or her personal residence, in addition to the post-move notice described in item 2, you must mail a notice of your intent to change the conservatee’s residence to the conservatee, the conservatee’s attorney, if any, and to each other per: o notice of the hearing 7 appoi as conservator; and then you must file with the court proof that the notice was mailed. Unless there is an emergency requiring a shorter period of notice, this notice must be mailed at least 15 days before the date of the proposed move. (There is a court form you must use for this notice and another form you may use to prove that you have mailed it. The forms are the Pre-Move Notice of Proposed Change of Personal Residence of Conservatee or Ward (form GC-079) and the Attachment to Pre-Move Notice, etc. (form GC-079(MA). These forms refer to a “pre-move notice” because the notice must be mailed before the move.) o notice of the hearin
5. If you want to establish the conservatee’s residence outside California, you must petition the court for permission before the move. Notice of the court hearing on this petition, together with a copy of the petition, must be mailed to the conservatee and the other persons and entities that were entitled to notice of the hearing on the petition for your appointment as conservator. There is a court form for this petition, the Petition 1o Fix Residence Outside the State of California (form GC-085). Notice of the hearing and proof of its mailing is given on another court form, the Notice of Hearing—Guardianship or Conservatorship (form GC-020).
6. You may not place the conservatee involuntarily in a mental health treatment facility unless he or she has been determined to be gravely disabled as the result of a mental disorder or impairment by chronic alcoholism, you have been appointed as conservator under the Lanterman-Petris-Short Act (Welf. & Inst. Code, § 5350 et seq.). and then only if the court has authorized the placement. If the court has authorized you to place the conservatee in a secured-perimeter residential care facility or a locked and secured nursing facility because he or she suffers from dementia. you must be sure that the placement is the Jeast restrictive placement appropriate to the conservatee’s needs GC-348 (Rev. January 1, 2011] . DUTIES OF CONSERVATOR : Page 2 of 7 and Acknowledgment of Receipt of Handbook for Conservators (Probate—Guardianships and Conservatorships)

GC-348 ~ CONSERVATORSHIP OF (Name). ~ CASE NUMBER CONSERVATEE Ill. C. PROVIDE MEDICAL CARE FOR THE CONSERVATEE You are responsible for making sure that the conservatee’s health care needs are met. But there are special rules you must follow to meet these needs. Two of the most important rules are as follows: J. Unless the court has given you exclusive authority to consent to the conservatee’s medical treatment because the court has determined that the conservatee has lost the capacity to make sound medical decisions, your consent or refusal to consent to such treatment is not sufficient if the conservatee disagrees (except in certain emergency situations). If you do have exclusive medical consent authority, you should be sure that al] medical treatment and medications are appropriate. 2. If the conservatee has dementia and has lost the capacity to give an informed consent to the administration of medications for its treatment and care, you must be given specific authority by the court to consent to the administration of these medications. If you do have this authority, you should be sure that the medications are appropriate. D. WORK WITH THE PERSON(S) RESPONSIBLE FOR MANAGING THE CONSERVATEE’S PROPERTY If other persons are handling the conservatee’s property, such as his or her estate conservator, the conservatee’s spouse or registered domestic partner in possession of the couple’s marital or partnership property, or the trustee of a trust created for the management of the conservatee’s property and for his or her support, you must work together to be sure that the conservatee can afford the care you arrange. Purchases you make for the conservatee must be approved by the person(s) responsible for managing the conservatee’s assets or you may not be reimbursed or your reimbursement may be delayed. CONSERVATOR OF THE ESTATE The conservatee’s property or assets and income are known as the conservatee’s “estate.” If the court appoints you as conservator of the estate, you will manage the conservatee's finances, protect the conservatee’s income and property or assets, make an inventory of the conservatee’s property or assets, make sure the conservatee’s bills are paid, invest the conservatee’s money, see that the conservatee receives al] the income and benefits to which he or she is entitled, ensure that the conservatee’s tax returns are filed on time and aJ] taxes paid, keep accurate financial records, and regularly report the conservatee’s financial condition to the court. (Note: Property or assets and income in a trust for the conservatee's support and maintenance are usually not considered as part of the conservatee’s estate, particularly if the trust was created and funded before the appointment of a conservator. Unless the conservatee’s spouse or registered domestic partner consents to its inclusion in the conservatee’s estate, the community property of the conservatee and his or her spouse or registered domestic partner under the management and control of the spouse or partner is also not part of the conservatee’s estate.) A. MANAGING THE ESTATE J. Prudent management for the benefit of the conservatee; prudent investments < You must manage the estate’s property or assets and income for the benefit of the conservatee and with the care of a prudent person dealing with someone else’s property. You must not make unreasonably risky investments of money or property of the estate. 2. Prior court approval required for fees, borrowing, loans, and gifts You must ask and receive the court’s permission, after full disclosure of al] relevant facts, before you may pay from the conservatee’s estate fees to yourself for your services as conservator and to your attorney for his or her services to you: borrow money for or Joan money from the conservatee's estate (to yourself or anyone else); or make gifts of estate assets or property. 3. Keep estate money and property separate from your or anyone else’s money or property You must keep the money and property of the conservatee’s estate separate from your money or property or from the money or property of any other person. Never deposit estate funds in your persona] bank account or otherwise mix them with your or anyone else’s funds, even for brief periods. Title to individual stocks, bonds, or other securities; securities broker accounts: mutual funds; and accounts with banks and other financial institutions must show that these assets are nservatorship estate and not your or anyone else’s property. property of the c 4. Interest-bearing accounts and other investments Except for a checking account intended for payment of ordinary expenses, estate bank accounts must earn interest. You may deposit estate funds in one or more insured accounts in financial institutions, but you should not put more than the FDIC insurance limit, currently $250,000, in any single institution. You bave authority to make some investments without court approval. Other invesuments may be made only after court approval has been obtained. Consult with an attorney before making any investments, even those you have authority to make without court approval. GC-348 |Rev. January 1. 2011) DUTIES OF CONSERVATOR : Page Sol? and Acknowledgment of Receipt of Handbook for Conservators (Probate—Guardianships and Conservatorships)

CONSERVATORSHIP OF (Name): CASE NUMBER IV. A. 5. Claims against others on behaif of the conservatee Pursue claims against others on behalf of the conservatee’s estate when it is in the best interests of the conservatee or his or her estate to do so. The court may require you to be represented by a lawyer on on behalf of the conservatee’s estate. Consider requesting prior court authority to pursue or compromise large or complex claims, particularly those that might require litigation and the assistance of Jegal counsel and those that might result in an award of attorney fees for the other party against the conservatee’s estate if you are unsuccessful. You may sign a contingent fee agreement with legal counsel on behalf of the conservatee’s estate if such agreements are customary for the type of case involved, but the court must approve the agreement before it is enforceable. You may ask for court approval of a contingent fee agreement before signing it and before legal counsel performs any services under it. CONSERVATEE on on behalf of the Defend against actions or claims against the conservatee or his or her estate when it is in the best interest of the conservatee or the estate to do so. The court may require you to be represented by a lawyer for your defense of a lawsuit against the conservatee’s estate. You may request court approval or instructions concerning the defense or compromise of such a lawsuit. 7. Public and insurance benefits You must learn about and collect all public and insurance benefits for which the conservatee is eligible. 8. Evaluate the conservatee’s ability to manage cash and other assets . You should evaluate the conservatee’s ability to manage cash or other assets and take appropriate action, including asking for prior court approval when necessary or appropriate, to enable the conservatee to do $o to the level of his or her ability. 9. Locate the conservatee's estate planning documents You should undertake, as soon as possible after your appointment and qualification as conservator, to locate and take reasonable steps to ensure the safety of the conservatee's estate planning documents, including wills and codicils, living trusts, powers of attorney for health care and finances, life insurance policies, and pension records. . Preserve property mentioned in the conservatee's estate planning documents Make reasonable efforts to identify, locate, and preserve property mentioned in the conservatee’s estate planning documents. vet

JJ. Guard against inappropriate disclosure of the conservatee’s financial information Subject to your duty of full disclosure to the court and persons entitled under the law to receive it, you must closely guard against unnecessary or inappropriate disclosure of the conservatee's financial information. nN ’s tangible personai property a If you plan to dispose of any of the conservatee’s tangible personal property, inform the conservatee’s family members in advance and give them an opportunity to acquire the property, with approval or confirmation of the court. 33. Factors to consider when deciding whether to dispose of any of the conservatee’s property In deciding whether it is in the best interest of the conservatee to dispose of property of his or her estate, consider the following factors, among others, as appropriate in the circumstances: (A) The likely benefit or improvement of the conservatee’s fife that disposing of the property would bring; (B) The likelihood that the conservatee would need or benefit from the property in the future; (C) The previously expressed or current desires of the conservatee concerning the property, unless accommodating those desires would violate your fiduciary duty to the conservatee or impose an unreasonable expense on the estate; (D) The provisions of the conservatee’s estate plan concerning the property: (E) The tax consequences of disposing of the property; (F) The impact of disposition on the conservatee’s eligibility for public benefits: (G) The condition of the entire estate; (H) The likelihood that the property will deteriorate or be subject to waste if kept in the estate: and (1) The benefit versus the cost or liability of maintaining the property in the estate GC-348 [Rev. January 1, 2013) DUTIES OF CONSERVATOR Page 4 of 7 and Acknowledgment of Receipt of Handbook for Conservators (Probate—Guardianships and Conservatorships)

CONSERVATORSHIP OF (Name) : CASE NUMBER: CONSERVATEE IV.A. 14. Property, casualty, and liability insurance Determine the appropriate kinds and adequate levels of property, casualty, and liability insurance covering the property, assets, risks, and potential liabilities of the conservatee and his or her estate. Maintain the insurance in force during the entire period of the administration (except for assets after they are sold). 15. Communicate with conservator of the person and trustee You should communicate as necessary and appropriate with the conservator of the conservatee’s person, if any, and with the trustee of any trust of which the conservatee is a beneficiary. 16. Other limitations or restrictions There are many limitations or restrictions on your authority to deal with estate assets not mentioned here. Jf you do not obtain the court’s permission when it is required before taking an action, you may be removed as conservator or you may be required to reimburse the estate from your own personal funds, or both. B. INVENTORY OF ESTATE PROPERTY

1. Locate and take possession of the estate's property and prepare an inventory You must identify, locate, take possession of, and protect all the conservatee’s property, assets, and income that wil] be or become part of the conservatorship estate. You must change the record title or ownership of most property and assets of the estate to reflect the conservatorship. You must record a copy of your Letters of Conservatorship (form GC-350) with the county recorder in each county where the conservatee owns real property. You must then prepare an inventory, or a list, of all of the real and personal property of the estate. There are court forms that must be used for the inventory. These consist of a two-page cover sheet, Inventory and Appraisal (form DE-160/GC-040) and one or more pages to be attached to the cover sheet containing the list of property, Jnventory and Appraisal Attachment (form DE-161/GC-041). The property is separated into two categories, cash and cash-equivalent items, listed on Attachment 1; and all other types of real and personal property, listed on Attachment 2.
2. Determine the value of the estate’s property You must arrange to have a probate referee appointed by the court appraise, or determine the fair market value of, the noncash property of the estate shown in Attachment 2 of your inventory unless the referee’s appointment is waived by the court. You, rather than the referee, may appraise the value of the cash and cash-equivalent items of property listed in Attachment 1, such as bank accounts.
3. File and mail copies of the inventory and appraisal and notice of how to object Within 90 days after your appointment as conservator, unless the court gives you more time, you must file with the court your inventory containing the appraisals of estate property, signed by you and, if the probate referee has appraised assets, by the referee. You must also mail copies of the completed inventory and appraisal to the conservatee. the conservatee’s attomey, if any, and the conservatee’s spouse or registered domestic partner, parents, and children. and must give them written notice of how to file an objection to the inventory and appraisal. There is a court form that must be used for this notice, the Notice of Filing of Inventory and Appraisal and How to Object to the Inventory or the Appraised Value of Property (form GC-042) C. RECORD KEEPING AND ACCOUNTING
4. Keep records and prepare accountings You must keep complete and accurate records of each financial transaction affecting the estate, including all receipts of income, changes in assets or property held in the estate, and expenditures. The checkbook for the conservatorship checking account is your indispensable tool for keeping records of income and expenditures. You should also save original bills or invoices paid, records of property sale transactions, receipts for money spent. and bank or other institutions’ statements showing income received and money spent. You must prepare periodic accountings of all money and property you have received, what you have spent, the date of each transaction, and its purpose. Your accountings must describe in detail what you have Jeft after you pay the estate’s expenses. There are court forms you may. or in some situations must, use for your accountings. You wil] have to file original statements from banks and other insurutions with your accountings. GC-348 (Rev. January 7. 2011) DUTIES OF CONSERVATOR : Page Sof? and Acknowledgment of Receipt of Handbook for Conservators (Probate—Guardianships and Conservatorships)

GC-348 CONSERVATORSHIP OF (Name): ~ CASE NUMBER’ CONSERVATEE IV. C. 2. Court review of your accountings and records You must file with the court a report with each of your accountings that shows the current circumstances of the conservatee and the estate, along with a petition requesting t H unting. Your first accounting is due one year after your appointment, and later accountings must be filed at least every two years after that. The court may order you to file more frequent accountings. You must save your receipts and other original records because the court may ask to review them. If you do not file your accountings as required, the court will order yon to do so. You may be removed as conservator if you fail to properly preparc and file your accountings or comply with the court’s orders. Vv. DUTY TO DISCLOSE CHANGES IN MARITAL OR DOMESTIC PARTNERSHIP STATUS If you are the spouse of the conservatee, you must disclose to the court, and give notice to interested persons under the Probate Code, of the filing of any action or proceeding against the conservatee for (1) legal separation, (2) dissolution of marriage, or (3) adjudication of nullity of the marriage. If you are or were the registered domestic partner of the conservatee, you must disclose to the court any termination of the domestic partnership. The disclosure must be made within 10 days of the initial filing of the action or proceeding or termination of the partnership by filing a notice with the court. If you are not the spouse or registered domestic partner or former partner of the conservatee and one of these events occurs, the conservatee’s spouse or former registered domestic partner must disclose the event to you within the same 10-day period. Vi LIMITED CONSERVATOR (for the developmentally disabled only) A. AUTHORITY SPECIFIED IN YOUR LETTERS OF CONSERVATORSHIP AND APPOINTMENT ORDER If the court appoints you as limited conservator, you wil] have authority to take care of only those aspects of the conservatee's life and fmancial affairs specified in your Letiers of Conservatorship and the court's order appointing you. The conservatee retains all other legal and civil rights. Although most of the information provided in this form also applies to limited conservatorships (especially the duties of the conservator of the person), you should clarify with your attorney exactly which information applies in your case. B. DUTY TO HELP LIMITED CONSERVATEE DEVELOP SELF-RELIANCE You must secure treatment, services, and opportunities that will assist the limited conservatee to develop maximum self-reliance and independence. This assistance may include training, education, medical and psychological services, social Opportunities, vocational opportunities, and other appropriate help. C. DETERMINATION OF LEVEL OF CARE FOR CERTAIN LIMITED CONSERVATEES The on described in itern HA does noi apply to a limited conservatee who receives services ma regional center for the developmentally disabled and for whom the Director of Developmental Services or the regional center is acting as conservator. Determination of the services provided for and residential placement of these limited conservatees are to be identified, delivered, and evaluated consistent with the individual program plan process described in Welfare and Institutions Code sections 4640-4659. (See Prob. Code, § 2352.5(e).) Vil. TEMPORARY CONSERVATOR If the court appoints you as temporary conservator, you will generally have the same duties and authority as general conservators, except the conservatorship will end on the date specified in your Leiers of Temporary Conservatorship. Most of the information in this form also applies to temporary conservatorships. but you must consult your attorney about which duties you will not perform because of the short duration of the temporary conservatorship appointment. A temporary conservator should avoid making iong-term decisions or changes that could safely wait until a general conservator is appointed. As temporary conservator, you may not. move a conservatee from his or her home, unless there is an emergency, or sell or give away the conservatee's home or any other assets without prior court approval. Sign the Acknowledgment of Receipt on page 7. GC-348 [Rev. January 1, 2011} 7 7 DUTIES OF CONSERVATOR _ Page 6 of 7 and Acknowledgment of Receipt of Handbook for Conservators (Probate—Guardianships and Conservatorships)

GC-348 CONSERVATORSHIP OF (Name): CASE NUMBER: _CONSERVATEE ‘Vill. JUDICIAL COUNCIL FORMS This form identifies'a number of Judicial Council forms used for court filings in conservatorship proceedings. This form, the petition for your appointment as conservator, and the order that appoints you as conservator are examples of Judicial Council forms. Judicial Council forms are either mandatory or optional. If a mandatory form applies to a situation or proposed action, it must be used. Optional forms may be used, at the option of the person preparing and filing the form or, in some situations, at the option of the court. Each form is identified on the bottom left side of its first page as optional or mandatory. Judicial Council forms are not available for every situation where a document may or must be filed with the court, but the forms address the most common and important matters that occur during a conservatorship. The Handbook for Conservators has additional information about Judicial Council conservatorship forms. Your attorney will select and prepare the appropriate Judicial Council forms. However, if you do not have an attomey, you can prepare them yourself. All Judicial Council forms are posted on the California courts’ public website, www.courts.ca.gov. Select “Forms” at the top of the site's home page, then select the form group in the drop-down menu in the middle of the page. All conservatorship forms are collected in the Probate—Guardianships and Conservatorships form group. They are designated with the prefix “GC,” followed by a three-digit number. Forms shown in the drop-down list with an asterisk are mandatory forms. The forms are posted on the website in both unfillable and fillable versions, as PDF files. The unfillable versions are designed to be completed by typewriter or, in some cases, by hand. Fillable forms may be filled out online, then printed out ready for signing and filing with the court, and they may also be saved to your computer and completed in more than one sitting. Go to the “Forms and Information” page at the Web site’s Self-Help Center for more information on accessing the forms. ACKNOWLEDGMENT OF RECEIPT of Duties of Conservator and Handbook for Conservators (Probate Code, § 1834) ] acknowledge that I have received this statement of the duties and liabilities of the office of conservator, the Duties of Conservator (form GC-348), and the Handbook for Conservators adopted by the Judicial Council. . I declare under penalty of perjury under the Jaws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME) (SIGNATURE OF (PROPOSED) CONSERVATOR, Date: (TYPE OR PRINT NAME) {SIGNATURE OF (PROPOSED) CONSERVATOR Date: (TYPE OR PRINT NAME) {SIGNATURE OF «Ph POSED) CONSERVATOR NOTICE This statement of duties and liabilities is a summary and is not a complete statement of the law. Your conduct as a conservator is governed by the law itself and not by this summary or by the Judicial Council's Handbook for Conservators. When in doubt, consult your attorney. GC. 343 (Rev. January 1 2011) DUTIES OF CONSERVATOR Page 7 of 7 and Acknowledgment of Receipt of Handbook for Conservators (Probate—Guardianships and Conservatorships)

GC-320 ATTORNEY OR PARTY WITHOUT ATTORNEY. STATE BAR NO.: FOR COURT USE ONLY NAME FIRM NAME STREET ADDRESS: city: STATE: ZIP CODE TELEPHONE NO.: FAX NO. —-MAIL ADDRESS: ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS STREET ADDRESS: 801 10TH STREET, 4TH FLOOR MAILING ADDRESS: 801 10TH STREET, 4TH FLOOR CITY AND ziIPCoDE: +~MODESTO, CA 95354 BRANCH NAME: CONSERVATORSHIP OF THE [_] PERSON {"] ESTATE of (name): PROPOSED CONSERVATEE CITATION FOR CONSERVATORSHIP CASE NUMBER: {_] Limited Conservatorship THE PEOPLE OF THE STATE OF CALIFORNIA, To (name): 1. You are hereby cited and required to appear at a hearing in this court on a. Date: Time: [] Dept.: Room: b. Address of court: [_ same as noted above [x ] other (specify): 801 10TH STREET, 6TH FLOOR and to give any legal reason why, according to the verified petition filed with this court, you should not be found to be ] unable to provide for your personal needs unable to manage your financial resources and by reason thereof, why the following person should not be appointed [] conservator [—] limited conservator of your [__] person —] estate (name): A conservatorship of the person may be created for a person who is unable properly to provide for his or her personal needs for physical health, food, clothing, or shelter. A conservatorship of the property (estate) may be created for a person who is unable to resist fraud or undue influence, or who is substantially unable to manage his or her own financial resources. Substantial 5 1 29 1 3 20 1481 1342 84 22 88.796280 inability may not be proved solely by isolated incidents of negligence or improvidence. At the hearing a conservator’ may be appointed for your person estate. The appointment may affect or transfer to the conservator your right to contract, to manage and control your property, to give informed consent for medical treatment, to fix your place of residence, and to marry. You may be disqualified from voting if you are found to be incapable of communicating, with or without reasonable accommodations, a desire to participate in the voting process. You will not be disqualified from voting on the basis that you do, or would need to do, any of the following to complete an affidavit of voter registration: a. Sign the affidavit of voter registration with a mark or a cross, pursuant to Section 2150(b) of the Elections Code; b. Sign the affidavit of voter registration by means of a signature stamp pursuant to Section 354.5 of the Elections Code; c. Complete the affidavit of voter registration with the assistance of another person pursuant to Section 2150(d) of the Elections Code; or d. Complete the affidavit of voter registration with reasonable accommodations The judge or the court investigator will explain to you the nature, purpose, and effect of the proceedings and answer questions concerning the explanation. CONTINUED ON PAGE 2. THE CLERK'S SEAL IS ALSO ON THAT PAGE.

fed for Mandatory Use CITATION FOR CONSERVATORSHIP Probate Code. § 1823 inci of California GC-320 www Cours C3 gov {Rev July 1 2016) (Probate—Guardianships and Conservatorships)

GC-320 CONSERVATORSHIP OF THE [| PERSON (]estATE—— CASE NUMBER: of (name): PROPOSED CONSERVATEE 6. You have the right to appear at the hearing and oppose the petition. You have the right to hire an attorney of your choice to represent you. The court will appoint an attorney to represent you if you are unable to retain one. You must pay the cost of that attorney if you are able. You have the right to a jury trial if you wish. 7. (For limited conservatorship only) \n addition to the rights stated in item 6 above, you have the right to oppose the petition in part by objecting to any or all of the requested duties or powere of the limited conservator. Date: Clerk, by , Deputy Assistive listening systems, computer-assisted real-time captioning, or sign language _.

|| interpreter services are available upon request if at least 5 days notice is provided. Contact

the clerk's office for Request for Accommodations by Persons With Disabilities and Order 410). (C de secti : | GC-320 [Rev. July 1. 2016} CITATION FOR CONSERVATORSHIP Page 2 of 3 (Probate—Guardianships and Conservatorships)

GC-320 CONSERVATORSHIP OF THE [] PERSON ESTATE CASE NUMBER: of (name): PROPOSED CONSERVATEE PROOF OF SERVICE 4. Atthe time of service | was at least 18 years of age and not a party to this proceeding. | served copies of the Citation for Conservatorship and the Petition for Appointment of Probate Conservator (form GC-310) as follows: 2. a. Person cited (name): b. Person served: (1) [] person in item 2a (2) |] other (specify name and title or relationship to the person named in item 2a): c. Address (specify): 3. | served the person named in item 2 a. [7] by personally delivering the copies (1) on (date): (2) at (time): b. [__] by mailing the copies to the person served, addressed as shown in item 2c, by first-class mail, postage prepaid, (1) on (date): (2) from (city): (3) [] with two copies of the Notice and Acknowledgment of Receipt—Civil and a postage-paid return envelope addressed to me. (Altach completed Notice and Acknowledgment of Receipt—Civil (form POS-015).) (4) [-] to an address outside California with return receipt requested. (Attach completed return receipt.) c. [__] other (specify other manner of service, and the authorizing code section and order of the court): 4. a. Person serving (name, address, and telephone number): . [] Fee for service: $ . [_] Nota registered California process server {-] Exempt from registration under Business and Professions Code section 22350(b) . {] Registered California process server (1) [-] Employee or independent contractor. (2) Registration no. (specify): (3) County (specify): (4) Expiration (date) oF oa 5. [7] | declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct 6. _] !am a California sheriff or marshal and | certify that the foregoing is true and correct

Date: (SIGNATURE OF PERSON SERVING) GC-320 [Rev. July 1, 2016} CITATION FOR CONSERVATORSHIP. Page 30f3 (Probate—Guardianships and Conservatorships)

_ GC-020° FOR COURT USE ONLY ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Stale Bar number, and address). TELEPHONE NO. FAX NO. (Optional) E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS street aooress: 801 10TH STREET, 4TH FLOOR maine aooress: 801 1OTH STREET, 4TH FLOOR civ ann zipcove:. MODESTO, CA 95354 BRANCH NAME: CONSERVATORSHIP OF THE [] PERSON [_] ESTATE [J GuarDIANsHIP OF (Name): {] minor (PROPOSED) CONSERVATEE. CASE NUMBER: NOTICE OF HEARING—GUARDIANSHIP OR CONSERVATORSHIP © This notice is required by law. This notice does not require you to appear in court, but you may attend the hearing if you wish.

1. NOTICE is given that (name): (representative capacity, if any): has filed (specify):
2. You may refer to documents on file in this proceeding for more information. (Some documents filed with the court are confidential. Under some circumstances you or your attorney may be able to see or receive copies of confidential documents if you file papers in the proceeding or apply to the court.)
3. [] The petition includes an application for the independent exercise of powers by a guardian or conservator under ([-] Probate Code section 2108 C Probate Code section 2590. Powers requested are [] specifiedbelow [] specified in Attachment 3.
4. AHEARING on the matter will be held as follows: a. Date: Time: {-] Dept [] Room: b. Address of court [] same as noted above [Vv_] is (specify): 801 JOTH STREET, 6TH FLOOR MODESTO, CA 95354 Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available upon request if at least 5 days notice is provided. Contact the clerk's office for Request for Accommodations by Persons with Disabilities and Order (form MC-410). (Civil Code section 54.8.)

Probate Code. §§ 1264 for Mandatory Uses NOTICE OF HEARING—GUARDIANSHIP OR CONSERVATORSHIP 160.1469. 1511, 1022 of Calitornia 4 r {Rev July 1. 2005} (Probate—Guardianships and Conservatorships) veww. courtinta C3. gov

GUARDIANSHIP Yj CONSERVATORSHIP OFTHE [_] PERSON [ ESTATE | CASE NUMBER: OF (Name) MINOR iv (PROPOSED) CONSERVATEE NOTE: * A copy of this Nolice of Hearing—Guardianship or Conservatorship ("Notice") must be served on—delivered to—each person who has the right under the law to be notified of the date, time, place, and purpose of a court hearing in a guardianship or conservatorship. Copies of this Notice may be served by mail in most situations. Ina guardianship, however, copies of this Notice must sometimes be personally served on certain persons; and copies of this Notice may be personally served instead of served by mail in both guardianships and conservatorships. The petitioner (the person who requested the court hearing) may not personally perform either service by mail or personal service, but must show the court that copies of this Notice have been served in a way the law allows. The petitioner does this by arranging for someone else to perform the service and complete and sign a proof of service, which the petitioner then files with the original Notice. This page contains a proof of service that may be used only to show service by mail. To show personal service, each person who performs the service must complete and sign a proof of personal service, and each signed copy of that proof of service must be attached to this Notice when it is filed with the court... You may use form GC-020(P) io show personal service of this Notice.

• (This Note replaces the clerk's certificate of posting on prior versions of this form. If notice by posting is desired, attach a copy of form GC-020(C), Clerk's Certificate of Post 1g Notice of Hearing—Guardianship or Conservatorship. (See Prob. Code, § 2543(c).) PROOF OF SERVICE BY MAIL.

1. 1am over the age of 18 and not a party to this cause. | am a resident of or employed in the county where the mailing occurred. My residence or business address is (specify):
2. Iserved the foregoing Notice of Hearing—Guardianship or Conservatorship on each person named below by enclosing a copy in an envelope addressed as shown below AND a C_] depositing the sealed envelope with the United States Postal Service on the date and at the place shown in item 4 with the postage fully prepaid. b. C7] placing the envelope for collection and mailing on the date and at the place shown in item 4 following our ordinary business practices. | am readily familiar with this business's practice for collecting and processing correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with postage fully prepaid.
3. a. Date mailed: b. Place mailed (city, state):
4. C_] I served with the Notice of Hearing—Guardianship or Conservatorship a copy of the petition or other document referred to in the Notice

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

Date: N P — La ~ (TYPE OR PRINT NAME OF PERSON COMPLETING T HIS FORM) (SIGNATURE OF PERSON COMPLETING THIS FORM) NAME AND ADDRESS OF EACH PERSON TO WHOM NOTICE WAS MAILED Name of person served Address (number, street, city, state, and zip code) 1 — — 2, - ~ | ] == SSS a = 4, - | [] Continued on an attachment. (You may use form DE-120(MA)/GC-020(MA) to show additional persons served.) GC-020 |Rev. July 1, 2005} NOTICE OF HEARING—GUARDIANSHIP OR CONSERVATORSHIP Page 2 of 2 (Probate—Guardianships and Conservatorships)

7] ESTATE [-] GUARDIANSHIP [-X ] CONSERVATORSHIP = [__] MATTER OF | CASE NUMBER: (Name): ATTACHMENT TO NOTICE OF HEARING PROOF OF SERVICE BY MAIL (This Attachment is for use with forms DE-120 and GC-020.) NAME AND ADDRESS OF EACH PERSON TO WHOM NOTICE WAS MAILED No. Name of person served Address (number, street, city, state, and zip code) DE-120(MA)IGC-020(MA) [

| |

Form Approved er Opera ee ATTACHMENT TO NOTICE OF HEARING PROOF OF SERVICE BY MAIL way (Probate—Decedents’ Estates and Guardianships and Conservatorships) DE-120(MAYGC-02 [New July 1, 2005} www Courts ca gov

CONFIDENTIAL GC-335 ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY NAME: FILE IN CONFIDENTIAL FOLDER FIRM NAME: STREET ADDRESS: city: STATE: ZIP CODE: TELEPHONE NO. FAX NO EMAIL ADDRESS: ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS STREET ADDRESS: 801 10TH STREET, 4TH FLOOR MAILING ADDRESS: 801 10TH STREET, 4TH FLOOR CITY AND zip CODE: MODESTO, CA 95354 BRANCH NAME: CONSERVATORSHIP OF THE [] PERSON {L_] ESTATE OF CASE NUMBER: (name): CONSERVATEE _[] PROPOSED CONSERVATEE CONFIDENTIAL CAPACITY ASSESSMENT AND HEARING DATE: TIME DEPT. or ROOM: DECLARATION—PROBATE CONSERVATORSHIP This form is intended to record the results of a capacity assessment of the person named in item 2, to describe the assessing clinician's conclusions about the person's mental functioning and capacity, and to submit the results and conclusions under oath to the court. The petitioner completes items 1 and 2 to give instructions to the clinician. The clinician completes the remainder of the form. PETITIONER'S INSTRUCTIONS TO CLINICIAN

1. Assessments requested. In addition to completing Parts | and II (pages 2—4), please complete the following items in Part Ill (pages 5-6) to assess the person's ability to perform the action or capacity to make the decision indicated (check all that apply): a. [] Item 20: Give or withhold informed consent to medical treatment specified in the petition. (Prob. Code, §§ 811, 813, 2357.) b. [-] Item 21: Give or withhold informed consent to medical treatment generally. (/d., §§ 811, 1880-1891, 2355.) c. [_] Item 22: Give or withhold informed consent to placement in a secured-perimeter (locked) residential care facility for the elderly. (/d., §§ 811, 2356.5.) d. [__] Item 23: Give or withhold informed consent to administration of medication appropriate for care and treatment of major neurocognitive disorders (e.g., dementia). (/d., §§ 811, 813, 2356.5.) . Note to petitioner: Provide a copy of the petition to the clinician who will be assessing the person named in item 2 for the clinician's reference. Do not attach Confidential Supplemental Information (form GC-312).
2. Person to be assessed a. Name: b. Address: Telephone number: Email address: Date of birth: Highest level of education completed (grade or degree): Marital or partnership status: [—] single [—] married/partnered [] dissolved [] widowed Preferred language: [-_] speaks [] reads [] writes m~e ao TO THE CLINICIAN: Provide your contact and license information below.
3. a. Name: b. Office address: Telephone number: Email address:
4. a. [-] | ama California-licensed physician. License no: b. [__] | am a California-licensed psychologist practicing within the scope of my license. License no: [] | have at least two years' experience diagnosing major neurocognitive disorders (including dementia). c. Ihave been practicing as a licensed physician or psychologist for years.

Fe Ad 1d for Mand: U: 5 |-813, judicial Councl of California. CONFIDENTIAL CAPACITY ASSESSMENT AND Probate Code, §§ 811-813 GC-335 (Rev. January 1, 2025} DECLARATION—PROBATE CONSERVATORSHIP wwww.courts.ca,gov

CONFIDENTIAL GC-335 CONSERVATORSHIP OF THE [|] PERSON [| ESTATE OF CASE NUMBER (name): CONSERVATEE PROPOSED CONSERVATEE Information about the assessment 5. a. The person named initem2 []is [7_] isnot apatient under my continuing care and treatment. b. | have known this person for (specify length of time in months or years): 6. a. Date of the examination on which this assessment is based or, if based on multiple examinations, the date | most recently examined the person: b. Time spent in most recent examination: 7. My responses to the questions and prompts on this form are based on (check all that apply): a. [] My examination of this person for the purpose of assessing the person's abilities and capacities. b. [] Multiple examinations of this person for purposes of general health care and medical treatment. c. [] Administration of standardized examinations or tools that measure the person's mental functioning. All tests administered and dates of administration are listed [] below [] in Attachment 7c. a . [] My review of the person's medical records. . [] Discussions with other practitioners responsible for providing health care to the person. These discussions are described [--] below [] in Attachment 7e. oO [] Discussions with team members or other professionals who participated in the person's assessment. These discussions are described [] below [] in Attachment 7f. g. [] Discussions with the person's family or friends; names and relationships are given [—]| below [__] in Attachment 7g. = . [-] Other sources of information, which are described [—] below [] in Attachment 7h. REPORT OF ASSESSMENT lf a question or prompt does not apply to an ability or capacity checked in item 1 or your assessment does not address a question or prompt, please check the appropriate box in that item or, if there is no box, leave the item blank. Secure or destroy your copy of the petition. Do not send it to the court. PART i. GENERAL PHYSICAL AND MENTAL HEALTH This part describes the general state of the physical and mental heaith of the person named in item 2. [] Information focused on the effect of the person's health on their mental function is given in items 16-18. 8. Physical health a. Overall physical health is: [__] Excellent [-] Good [] Fair [__] Poor [—] | don'tknow b. Overall physical health is likely to: [] Improve [_] Remainstable [] Deteriorate [] I don't know [_] The person should be reevaluated in weeks. c. Chronic conditions that require ongoing care and treatment are listed [] below [] in Attachment 8c. 9. Mental health a. Overall mental health is: [] Excellent [-] Good [__] Fair [-] Poor [] I don'tknow b. Overall mental health is likely to. [[_] Improve [] Remainstable [] Deteriorate [-] I don'tknow [_] The person should be reevaluated in weeks. c. All known diagnosed mental health disorders (current Diagnostic and Statistical Manual of Mental Disorders) are listed [-] below [(_] in Attachment 9c. GC-836 [Rev January 1, 2025] CONFIDENTIAL CAPACITY ASSESSMENT AND Page 2 0f 6 DECLARATION—PROBATE CONSERVATORSHIP

CONFIDENTIAL GC-335 CONSERVATORSHIP OF THE [ ] PERSON [] ESTATE OF CASE NUMBER: (name): CONSERVATEE PROPOSED CONSERVATEE PART Il. MENTAL FUNCTIONING This part documents the existence and extent of any deficits found by my assessment of the mental functioning of the person described in item 2. Deficits are indicated in items 10-14 as follows: [a = no deficit; b = mild deficit, c = moderate deficit; d = major deficit or no function; e = not applicable or not assessed] 10. Alertness and attention (ability to recognize and react to a stimulus) a. Level of arousal or consciousness (deficit may be shown by lethargy, lack of response without constant stimulation, or stupor) L_ja [|b [le [jd [Je b. Orientation to: (1) Time (When? Year, month, day, hour) [ja [_]b [Je L-jd L_le (2) Place (Where? State, city, address) L_ja [] b Lijec Ljd Lje (3) Person (Who? Name, relationship) Loja [-] b Li oje Lt jd LCL oJe (4) Situation (What? How? Why?) [ja [Jb [Cle Lod L_Je c. Ability to attend to and concentrate on tasks (ability to attend to a stimulus; concentrate on a stimulus over brief time periods) [ja L_Jb L_Je L_jd [Je Notes: 11. Information processing a. Memory (1) Immediate recall [ja LJ] b Lo Je Coda [Je (2) Short-term memory and learning (the ability to encode, store, and retrieve information) [L_Jja L_]b L_Je Cd [Je (3) Long-term memory (ability to remember information from the past) L_ja L_]b L_Je L_jd Cle b. Understanding (the ability to receive and accurately process information given in written, spoken, visual, or other media) LC Ja LJ b [Je [jd [Je c. Communication (the ability to express oneself and indicate preferences in speech, writing, signs, pictures, etc.) [ja [Jb LoJe [jd [Je d. Visual-spatial reasoning (recognition of familiar objects; spatial perception, problem solving, and design) [Ja Cj] b [Je [Jd [Je e. Quantitative reasoning (the ability to understand basic quantities and make simple calculations) [Ja []b L Je [Jd [le f. Verbal reasoning (the ability to compare options, to reason using abstract concepts, and to reason logically about outcomes) [ja L_]b L Je | C Je g. Executive functioning (the ability to plan, organize, and carry out actions (assuming physical ability) in one's own rational self-interest) [Ja [|b L_Je :) LJe Notes: 12. Thought processes a. Organization of thinking (deficit may be demonstrated by severely disorganized, nonsensical, or incoherent thinking) L Ja [_]b LJe¢ LJd Cle b. Correspondence of thoughts to reality (deficit may be demonstrated by hallucinations or delusions) L_la [|b Le (Jd Lje c. Control of thoughts (deficit may be demonstrated by uncontrollable, repetitive, or intrusive thoughts) L ja [__]b Lo Je [jd C-Je Notes: SC-896 [Rev. January 1, 2026) CONFIDENTIAL CAPACITY ASSESSMENT AND Page 3 ofS DECLARATION—PROBATE CONSERVATORSHIP

CONFIDENTIAL GC-335 CONSERVATORSHIP OF THE [] PERSON [| ESTATE OF CASE NUMBER: (name): CONSERVATEE [] PROPOSED CONSERVATEE [a = no deficit; b = mild deficit; c = moderate deficit, d = major deficit or no function; e = not applicable or not assessed] 13. Ability to modulate mood and affect (deficit may be demonstrated by pervasive and persistent or recurrent mood or affect inappropriate in kind or degree to the circumstances) Loja LC] b L je [ ] d L_je Notes: 14. Ability to accept and cooperate with appropriate care or assistance (deficit may be demonstrated by inability to acknowledge illness or disorder, acting without regard for consequences, or inability or refusal to accept appropriate care) [Ja [] b L Je Lod [Je Notes: 15. Variation (some or all of the deficits noted above vary in frequency, severity, or duration): [J] Yes [-] No [Jidon'tknow Variation of deficits is described [] below [] in Attachment 15. Possible Temporary or Reversible Causes of Mental Function Deficits 16. Medications a. !s the person currently taking any medication—prescription or nonprescription—that may impair the person's mental functioning? (-J Yes [[] No [__]!don'tknow [] Not applicable If yes, each of those medications, with dosage and treatment indications, is listed [-] below [] in Attachment 16a. Name Dosage/Schedule Indications b. An explanation of the nature and severity of the impairment that each listed medication can cause is given [] below [] in Attachment 16b [—__] No medications listed. 17. Reversible causes Have temporary or reversible causes of mental impairment been considered, assessed, diagnosed, or treated? 1 Yes [TO TNo [77 I don't know causes considered are discusse belo — in Atachmen Yes No idon'tknow All causes considered are discussed below in Attachment 17. 18. Physical or emotional factors Are there physical or emotional factors (e.g., hearing, vision, or speech impairment; bereavement; or others) present that could diminish the person's capabilities and that could improve with time, treatment, or assistive devices? (-] Yes [-] No [] I don't know {] Applicable physical or emotional factors are described [] below [] in Attachment 18. Effect on Ability to Perform Everyday Activities 19. In my professional opinion, the mental function deficits, if any, identified in items 10-14 [] will [] willnot _ significantly impair the person's ability to perform some or all activities of daily living (e.g., eating, cooking, toileting, bathing, dressing) or instrumental activities of daily living (e.g., shopping, scheduling appointments, paying bills, using a credit card or checks, taking medication). More details about specific activities and reasons for my opinion are given (check all that apply): [J below [] in Attachment 19 [] in the attached Everyday Activities Attachment (form GC-335A). [__] | do not have enough information to form an opinion on this issue. GC-S36 FRev. January 1, 2025) CONFIDENTIAL CAPACITY ASSESSMENT AND Page 4 0f 6 DECLARATION—PROBATE CONSERVATORSHIP

CONFIDENTIAL GC-335 CONSERVATORSHIP OF THE [| PERSON [| ESTATE OF CASE NUMBER (name): CONSERVATEE PROPOSED CONSERVATEE PART Ill. CAPACITY TO GIVE OR WITHHOLD INFORMED CONSENT This part documents my professional conclusions about each issue checked in item 1. The conclusions are based on my assessment of the level of the person's mental functions described in Part Il. 20.[] Capacity to give or withhold informed consent to medical treatment specified in the petition (Probate Code, § 2357.) The following medical treatment has been recommended for the person (describe): Based on my assessment of the person's applicable mental functions and abilities, it is my professional opinion that: a [] b [ c [J The person has the capacity to give or withhold informed consent to the recommended medical treatment because the person can do all of the following: (1) respond knowingly and intelligently to questions about the treatment; (2) participate in the treatment decision by means of a rational thought process; and (3) understand (A) the nature and seriousness of the diagnosed disorder, (B) the nature of the recommended treatment, (C) the probable degree and duration of and benefits and risks of the recommended treatment, (D) the consequences of lack of treatment, and (E) the nature, risks, and benefits of any reasonable alternatives to the recommended treatment. The person lacks the capacity to give or withhold informed consent to the recommended medical treatment because the person cannot do at least one of the following: (1) respond knowingly and intelligently to questions about the treatment, (2) participate in the treatment decision by means of a rational thought process, or (3) understand at least one of the following: (A) the nature and seriousness of the diagnosed disorder, (B) the nature of the recommended treatment, (C) the probable degree and duration of and benefits and risks of the recommended treatment, (D) the consequences of lack of treatment, or (E) the nature, risks, and benefits of any reasonable alternatives to the recommended treatment. [] These conclusions are further explained [|] below [_] in Attachment 20b.

| do not have enough information to form an opinion on this issue.

21.[] Capacity to give or withhold informed consent to medical treatment generally (Probate Code, §§ 811, 1881.) Based on my assessment of the person's applicable mental functions and abilities, it is my professional opinion that: a [J The person has the capacity to give or withhold informed consent to medical treatment because the person can do aif of the following: (1) respond knowingly and intelligently to questions about at least some forms of medical treatment; (2) participate in at least some treatment decisions by means of a rational thought process; and (3) understand (A) the nature and seriousness of some diagnosed disorders, (B) the nature of some recommended treatments, (C) the probable degree and duration of and benefits and risks of at least some forms of treatment, (D) the consequences of lack of at least some forms of treatment, and (E) the nature, risks, and benefits of any reasonable alternatives to at least some forms of treatment. The person lacks the capacity to give or withhold informed consent to any form of medical treatment because either (1) the person is unable to respond knowingly and intelligently to questions about their medical treatment or (2) the person is unable to participate in treatment decisions by means of a rational thought process, which means the person cannot understand at least one of the following: (A) the nature and seriousness of any illness, disorder, or defect that they have or may develop; (B) the nature of any medical treatment that is or may be recommended by their health-care providers; (C) the probable degree and duration of any benefits and risks of any medical intervention that is or may be recommended by the person's health-care providers and the consequences of lack of treatment; or (D) the nature, risks, and benefits of any reasonable alternatives. The person's lack of capacity to give or withhold informed consent is linked to one or more mental function deficits described in Part Il. [-_] These conclusions are further explained [] below [] in Attachment 21b. c. [] | do not have enough information to form an opinion on this issue. 0-395 [Rev. January 1, 2025} CONFIDENTIAL CAPACITY ASSESSMENT AND

DECLARATION—PROBATE CONSERVATORSHIP

CONFIDENTIAL GC-335 CONSERVATORSHIP OF THE [] PERSON [] ESTATE OF CASE NUMBER: (name): CONSERVATEE [] PROPOSED CONSERVATEE 22.[] Capacity to give or withhold informed consent to placement in a secured-perimeter residential facility for persons with major neurocognitive disorders (Probate Code, § 2356.5.) a. {] The person has a major neurocognitive disorder (such as dementia) as defined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders. See Part | of this form for more information. b. [] The person needs or would benefit from placement in a restricted and secure environment for the reasons (for example, wandering, violence, or rejecting care) explained [—] below [] in Attachment 22b. c. Based on my assessment of the person's relevant mental functions and abilities, it is my professional opinion that: ) [-] The person has the capacity to give or withhold informed consent to this placement. ) [-] The person Jacks the capacity to give or withhold informed consent to this placement. The mental function deficit or deficits described in Part lI significantly impair the (proposed) conservatee's ability to understand and appreciate the consequences of giving consent to placement in a restricted, secured-perimeter residential facility. [-_] These conclusions are further explained [] below [] in Attachment 22c. d. The proposed placement in a locked or secured-perimeter facility [7] is [] isnot the least restrictive environment appropriate to the person's needs. e. [—] | do not have enough information to form an opinion on this issue. 23.[] Capacity to give or withhold informed consent to administration of medication for treatment of major neurocognitive disorders (Probate Code, § 2356.5.) a. [] The person has a major neurocognitive disorder (such as dementia) as defined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders. See Part | of this form for more information. b. [] The person needs or would benefit from appropriate medications for the care and treatment of major neurocognitive disorders (including dementia). Any medications and the need or potential benefit of each are described [-] below [] in Attachment 23b. c. Based on my assessment of the person's relevant mental functions and abilities, it is my professional opinion that:

1. [] The person has the capacity to give or withhold informed consent to the administration of medications appropriate for the care and treatment of major neurocognitive disorders (including dementia) (2) [] The person facks the capacity to give or withhoid informed consent to the administration of medications appropriate to the care and treatment of major neurocognitive disorders (including dementia). The mental function deficit or deficits described in Part Ill significantly impair the (proposed) conservatee's ability to understand and appreciate the consequences of giving consent to the administration of medications for the care and treatment of major neurocognitive disorders (including dementia). [] These conclusions are further explained [] below [] in Attachment 23c. d. [-_] ! do not have enough information to form an opinion on this issue. 24,[] Other information regarding my assessment of the person's mental functions, any deficits in those functions, and any resulting significant impairments to the person's ability to understand and appreciate the consequences of acts or decisions is given in Attachment 24.

25. Number of pages attached:

| 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) (SIGNATURE OF DECLARANT) GC-336 (Rev. January 1, 2025] CONFIDENTIAL CAPACITY ASSESSMENT AND Page 6 of 6 DECLARATION—PROBATE CONSERVATORSHIP

CONFIDENTIAL GC-335A CONSERVATORSHIP OF THE PERSON ESTATE OF CASE NUMBER: (name): CONSERVATEE PROPOSED CONSERVATEE EVERYDAY ACTIVITIES ATTACHMENT TO CONFIDENTIAL CAPACITY ASSESSMENT AND DECLARATION—PROBATE CONSERVATORSHIP (FORM GC-335) This form is for optional use in a probate conservatorship proceeding, in conjunction with Confidential Clinical Assessment and Declaration—Probate Conservatorship (form GC-335), to indicate the ability of the person described in item 1 to perform activities of daily living and instrumental activities of daily living. The person whose abilities are described on this form

1. a. Name: b. Address: Telephone number: Email address: Date of birth: The person who is completing this form
2. Name: b. Office address: Telephone number: Email address:
3. a. [] lama California-licensed [~ ] physician [] psychologist [] nurse practitioner [] physician assistant [] registered nurse [_] clinical social worker [] occupational therapist [__] other licensed professional (specify profession): b. My license number is: »
4. Check the box or boxes that apply to you. a. [-] | am the clinician who conducted the assessment of the person named in item 1 documented on the Confidential Clinical Assessment and Declaration—Probate Conservatorship (form GC-335) to which this form is attached, and | completed that form. The conclusions and opinions given in this form are based on the same assessment. b. [] | work or consult with the clinician who completed the Confidential Clinical Assessment and Declaration—Probate Conservatorship (form GC-335) to which this form is attached, and | participated in that clinician's assessment of the person named in item 1. The conclusions and opinions in this form are based on my participation in that assessment. c. [__] The conclusions and opinions given in this form are based on the application of my knowledge, experience, and training to my personal observations of the person named in item 1, as described below. Items 5-11 describe my conclusions about the ability of the person named in item 1 to perform activities in each of the listed categories based on information gathered as described in item 4. Activities of Daily Living (care of self and related activities)
5. Maintain adequate hygiene (for example, bathing, grooming, dressing, caring for teeth, going to the toilet) [-] Able; fully [__] Able with advice [-] Able only with [] Unable, even [-_] | don't know independent and passive support active assistance with assistance Comments [] below [__] in Attachment 5.

Fon Approved fr Onional Use EVERYDAY ACTIVITIES ATTACHMENT TO CONFIDENTIAL CAPACITY {ovate Code, sg 12002; 1001, GC-335A New January 7,202) ASSESSMENT AND DECLARATION—PROBATE CONSERVATORSHIP www couts.ca gov

CONFIDENTIAL GC-335A CONSERVATORSHIP OF THE PERSON [| ESTATE OF CASE NUMBER: (name): CONSERVATEE PROPOSED CONSERVATEE Activities of Daily Living (care of self and related activities) 6. Prepare meals and eat for adequate nutrition [] Able; fully [-] Able with advice [] Able only with [-] Unable, even [J | don't know independent and passive support active assistance with assistance Comments [-] below [] in Attachment 6. 7. Identify abuse or neglect and protect self from harm [J Able; fully [J Able with advice [] Able only with [-] Unable, even [-] | don't know independent and passive support active assistance with assistance Comments [] below [] in Attachment 7. Instrumental Activities of Daily Living 8. Financial (if appropriate, note dollar limits) a. Protect and spend small amounts of cash [-] Able; fully [J Able with advice [-_] Able only with (-~] Unable, even [J | don't know independent and passive support active assistance with assistance Comments [] below [] in Attachment 8a. b. Manage and use checks; pay monthly bills [-~] Able; fully L] Able with advice [7] Able only with [] Unable, even (J I don't know independent and passive support active assistance with assistance Comments [] below [[] in Attachment 8b. c. Enter into a contract (including, for example, to buy, sell, or lease real property or to obtain and use a credit card) [-] Able; fully [] Able with advice [4] Able only with [] Unable, even [J | don't know independent and passive support active assistance with assistance lepend c passive suppo ve assista assistance Comments [] below [] in Attachment 8c. 9. Resist fraud or undue influence (for example, has a history of being a victim of fraud or undue influence) [] Able; fully [] Able with advice [-{] Able only with [-] Unable, even [] | don't know independent and passive support active assistance with assistance Comments [7] below [] in Attachment 9. 10. Medical a. Choose and direct caregivers (-{) Able; fully [] Able with advice L] Able only with (-] Unable, even [_] | don't know independent and passive support active assistance with assistance Comments [] below [] in Attachment 10a. GC-336A [New January 1, 2028] EVERYDAY ACTIVITIES ATTACHMENT TO CONFIDENTIAL CAPACITY Page 2 of 4 ASSESSMENT AND DECLARATION—PROBATE CONSERVATORSHIP

CONFIDENTIAL GC-335A CONSERVATORSHIP OF THE PERSON ESTATE OF CASE NUMBER: (name): CONSERVATEE PROPOSED CONSERVATEE 10.b. Admit self to health-care facility [7] Able; fully [-] Able with advice [] Able only with [_] Unable, even [] I don't know independent and passive support active assistance with assistance Comments [] below [__] in Attachment 10b. c. Manage own medication (take proper dose as scheduled; refill or renew prescriptions as needed) [-~] Able; fully [] Able with advice L__] Able only with [-~] Unable, even [J I don't know independent and passive support active assistance with assistance Comments [] below [] in Attachment 10c. d. Contact help if ill or in an emergency [] Able; fully [) Able with advice [] Able only with [J Unable, even [J | don't know independent and passive support active assistance with assistance Comments [] below [] in Attachment 10d. 11. Home and community life a. Maintain a reasonably safe and clean home or other living environment; arrange for home maintenance or repair [] Able; fully [_] Able with advice (] Able only with [-] Unable, even [[] | don't know independent and passive support active assistance with assistance Comments [] below [] in Attachment 11a. b. Recognize and avoid common hazards (for example, a hot stove or poisons) [-] Able; fully [-] Able with advice [-] Able only with [J Unable, even = [] I don't know independent and passive support active assistance with assistance Comments [] below [] in Attachment 11b. c. Access transportation (for example, drive a car or use public transportation) [7] Able; fully [-_] Able with advice [-) Able only with [{] Unable, even [J] | don't know independent and passive support active assistance with assistance Comments [] below [] in Attachment 11c. d. Initiate and follow a schedule of daily activities [] Able; fully [-] Able with advice [-] Able only with [-_] Unable, even [J | don't know independent and passive support active assistance with assistance Comments [] below [__] in Attachment 11d. GC-336A [New January 1, 2025] EVERYDAY ACTIVITIES ATTACHMENT TO CONFIDENTIAL CAPACITY ASSESSMENT AND DECLARATION—PROBATE CONSERVATORSHIP

CONFIDENTIAL GC-335A CONSERVATORSHIP OF THE [] PERSON ESTATE OF CASE NUMBER: (name): CONSERVATEE PROPOSED CONSERVATEE 42.[] Other information regarding my assessment of the person's ability to perform activities of daily living or instrumental activities of daily living, including any significant impairments to that ability, is given [-] below [__] in Attachment 12. 13. Number of pages attached:

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

» (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT) Date: GC-335A [New January 1, 2026] EVERYDAY ACTIVITIES ATTACHMENT TO CONFIDENTIAL CAPACITY Page 4 of 4 ASSESSMENT AND DECLARATION—PROBATE CONSERVATORSHIP

GC-334 [ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY NAME FIRM NAME: STREET ADDRESS: city: STATE: ZIP CODE: TELEPHONE NO.: FAX NO. EMAIL ADDRESS: ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF Stanislaus STREET ADDRESS: 801 10th Street 4th Floor MAILING ADDRESS: 801 10th Street 4th Floor CITY AND ZIP CODE: Modesto. CA 95354 BRANCH NAME: CASE NUMBER: CONSERVATORSHIP OF THE [] PERSON [] ESTATE OF (name): CONSERVATORSHIP PETITION HEARING DATE: PROPOSED CONSERVATEE TIME: DEPT.: EX PARTE ORDER RE COMPLETION OF CAPACITY DECLARATION—HIPAA* 4. Attached to this order is a Confidential Capacity Assessment and Declaration—Probate Conservatorship (form GC-335) [-] and an Everyday Activities Attachment to Confidential Capacity Assessment and Declaration—Probate Conservatorship (form GC-335A) (the Declaration). 2. Applicant (name): having applied for an order authorizing the declarant(s) named in item 5 to complete, sign, and return the Declaration for the purpose specified in item 6, and good cause appearing: THE COURT FINDS 3. Notice of the hearing on the application should be dispensed with and the application should be granted. 4. A petition for the appointment of a conservator has been filed in this proceeding by (name of petitioner): This petition is set for hearing on (date): at (time): in [] Dept.: [J] Rm.:: 5, Declarant (name each): has been requested to complete and sign the Declaration for the purpose specified in item 6. 6. Petitioner proposes to use the Declaration to provide evidence to support (check all that apply): a. [] A finding that the proposed conservatee should be excused from attending the hearing on the petition. b. [7] A request for exclusive authority to consent to medical treatment for the proposed conservatee. c. [_] A request for authority to make placement and medication decisions related to treatment of a major neurocognitive disorder (including dementia). a . [-] The appointment of a conservator of the estate. . [-_] Other (specify): fo)

• The federal Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191). Judicial Council of California, courts.ca.gov Ex Parte Order re Completion of GC-334, Page 1 of 2 Rev. January 1, 2026, Mandatory Form Prob. Code, §§ 1801, 1872, 1890, 2356.5; i ion— Civ. Code, §§ 56.10, 56.13; 45 C.F.R. §§ 160, 164 Capacity Declaration HIPAA

GC-334 CONSERVATORSHIP OF (name): CASE NUMBER: PROPOSED CONSERVATEE THE COURT ORDERS 7. Notice of hearing on the application is dispensed with. 8. Each declarant named below is authorized to complete, sign, and deliver to the attorney or other person whose address appears at the top of page 1 of this order the original of the Declaration, consisting of: a. Confidential Capacity Assessment and Declaration—Probate Conservatorship (form GC-335) (name each authorized declarant): b. [-_] and Everyday Activities Attachment to Confidential Capacity Assessment and Declaration—Probate Conservatorship (form GC-335A) (name each authorized declarant): regarding (name of proposed conservatee): to enable the Court to determine whether the proposed conservatee should be excused from attending the hearing on the appointment of a conservator or the proposed conservator should be granted certain powers over the person or estate of the proposed conservatee. 9. Use of the Declaration is governed by the disclosure safeguards in the regulations of the federal Department of Health and Human Services (45 C.F.R. §§ 160 & 164) under HIPAA, and no use other than what is permitted in those regulations is permitted by this order. 40. The completed and signed original of the Declaration must be returned to the attorney or other person whose address appears at the top of this order within 15 days after its receipt by the declarant authorized to complete and sign it. 11. Other orders (specify): Date: JUDICIAL OFFICER CERTIFICATION

| certify that this document, including any attachments, is a correct copy of the original on file in my office.

Date: Clerk, by , Deputy (SEAL) Rev. January 1, 2026 Ex Parte Order re Completion of GC-334, Page 2 of 2 Capacity Declaration—HIPAA

GC-340 ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NO FOR COURT USE ONLY NAME: FIRM NAME: STREET ADDRESS: city: STATE ZIP CODE TELEPHONE NO.: FAX NO. E-MAIL ADDRESS: ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS STREET ADDRESS: 801 10TH STREET, 4TH FLOOR MAILING ADDRESS: 801 10TH STREET, 4TH FLOOR CITY AND ZIP CODE: © MODESTO; CA 95354 BRANCH NAME: CONSERVATORSHIP OF (name): CONSERVATEE ORDER APPOINTING [] SUCCESSOR CASE NUMBER: PROBATE CONSERVATOR OF THE [] PERSON [-_] ESTATE [__] Limited Conservatorship WARNING: THIS APPOINTMENT IS NOT EFFECTIVE UNTIL LETTERS HAVE ISSUED.

1. The petition for appointment of [-] successor conservator came on for hearing as follows (check boxes ¢, d, e, and f or g to indicate personal presence): a. Judicial officer (name): b. Hearing date: Time: {-] Dept.: [] Room: c. [x] Petitioner (name): d. [-] Attorney for petitioner (name): e. [] Attorney for [“] person cited ["__] the conservatee on petition to appoint successor conservator: (Name): (Telephone): (Address): f. [77] Person cited was [~] present {] unable to attend. [] able but unwilling to attend. [7] out of state. g. [-]} The conservatee on petition to appoint successor conservator was [-_] present. [__] not present. THE COURT FINDS
2. All notices required by law have been given
3. Granting the conservatorship is the least restrictive alternative needed for the protection of the conservatee.
4. (Name): a. [] is unable properly to provide for his or her personal needs for physical health, food, clothing, or shelter. b. [] is substantially unable to manage his or her financial resources or to resist fraud or undue influence. c. [__] has voluntarily requested appointment of a conservator and good cause has been shown for the appointment.
5. The conservatee a. [] is an adult. b. [_"] will be an adult on the effective date of this order. {<~] is a married minor. d. {] is a minor whose marriage has been dissolved
6. [-_] There is no form of medical treatment for which the conservatee has the capacity to give an informed consent {"__] The conservatee is an adherent of a religion defined in Probate Code section 2355(b).
7. ["~] Granting the {___] successor conservator powers to be exercised independently under Probate Code section 2590 is to the advantage and benefit and in the best interest of the conservatorship estate
8. [__] The conservatee cannot communicate, with or without reasonable accommodations, a desire to participate in the voting fe) process Do NOT use this form for a temporary conservatorship Page 1 of 3 Form Adopted for Mandatory Use ORDER APPOINTING PROBATE CONSERVATOR Probate Code. §§ 1830. 2688 www Courts Ca.gov Judicial Counci of Catiforma . . : 2-340 [Rev. January 15. 2016] (Probate--Guardianships and Conservatorships)

GC-340 CONSERVATORSHIP OF - CASE NUMBER (name): CONSERVATEE 9. [] The conservatec has dementia as defined in Probate Code section 2356.5, and the court finds all other facts required lo make the orders specified in item 28. 10. [] Atlorney (name): has been appointed by the court as legal counsel to represent the conservatee in these proceedings. The cost for representation is: $ The conservatee has the ability to pay [] all [~] none [] aportion of this sum (specify): $ 11.["] The conservatee need not attend the: hearing 12.[" | The appointed court investigator is (name): (Address and telephone): 13.[] (For limited conservatorship only) The limited conservatee is developmentally disabled as defined in Probate Code section 1420. 14.[| The successor conservator is a professional fiduciary as defined by Business and Professions Code section 6501(f). 15.[-] The [—] successor conservator holds a valid, unexpired, unsuspended license as a professionai fiduciary issued by the Professional Fiduciaries Bureau of the California Department of Consumer Affairs under chapter 6 (commencing with section 6500) of division 3 of the Business and Professions Code. License no.: Issuance or last renewal date: Expiration date: 16. (Either a, b, or c must be checked): a.. [—] The .| Successor _ conservator. is.not.the spouse.of.the conservatee..... . b. The - successor conservator is the spouse of the conservatee and is not a party to an action or proceeding against the conservatee for legal separation, dissolution, annulment, or adjudication of nullity of their marriage. c. [] The [{] successor conservator is the spouse of the conservatee and is a party to an action or proceeding against the conservatee for legal separation, dissolution, annulment, or adjudication of nullity of their marriage. itis in the best interest of the conservatee to appoint the spouse as [] successor conservator. 17. (Either a, b, or c must be checked): a The ["] successor conservator is not the domestic partner or former domestic partner of the conservatee. b. [ }] The [7] successor conservator is the domestic partner of the conservatee and has neither terminated nor intends to terminate their domestic partnership. c. [“_] The [] successor conservator is the domestic partner or former domestic partner of the conservatee and intends to terminate or has terminated their domestic partnership. itis in the best interest of the conservatee to appoint the domestic partner or former domestic partner'as ["] successor conservator. THE COURT ORDERS 18. a. (Name): (Telephone): (Address): is appointed[] successor [_]} conservator [7] limited conservator of the PERSON of (name): and Letters of Conservatorship shall issue upon qualification. b. (Name): (Telephone): (Address): is appointed[] successor [] conservator [_] limited conservator “ of the ESTATE of (name): and Letters of Conservatorship shall issue upon qualification. 19.[] The conservatee need not attend the hearing. 20. a. []} Bond is not required b. [j Bondis fixed at: $ to be furnished by an authorized surety company or as otherwise provided by law. c. [] Deposits of: $ are ordered to be placed in a blocked account at (specify institution and location) and receipts shall be filed. No withdrawals shall be made without a court order. {-~} Additional orders in attachment 20c GE-340 [Rev. January 15, 2016] ORDER APPOINTING PROBATE CONSERVATOR Page 2 of 3 (Probate—Guardianships and Conservatorships)

GC-340 CONSERVATORSHIP OF : CASE NUMBER (name): CONSERVATEE] | 20. (cont.) d. {-] The [] successor conservator is not authorized to take possession of money or any other properly without a specific court order. 21.[[_] For legal services rendered, [7] conservatee [{] conservatee's estate shall pay the sum of: $ to (name): (] forthwith as follows (specify terms, including any combination of payors): [7] Continued in attachment 21. 22.[] The conservatee is disqualified from voting. 23. [_] The conservatee lacks the capacity to give informed consent for medical treatment and the — [] successor conservator of the person is granted the powers specified in Probate Code section 2355. [] The treatment shall be performed by an accredited practitioner of a religion as defined in Probate Code section 2355(b). 24.[[] The [] successor conservator of the estate is granted authorization under Probate Code section 2590 to exercise independently the powers specified in attachment 24 [] subject to the conditions provided. 25.[] Orders relating to the capacity of the conservatee under Probate Code sections 1873 or 1901 as specified in attachment 25 are granted. 26.[—] Orders relating to the powers and duties of the | [] successor conservator of the person under Probate Code sections 2351-2358 as specified in attachment 26 are granted. (Do not include orders under Probate Code section 2356.5 relating to dementia.) 27.[] Orders relating to the conditions imposed under Probate Code section 2402 on the {[] successor conservator of the estate as specified in attachment 27 are granted. 28.[7] a. [7] The [-] successor conservator of the person is granted authority to place the conservatee in a care or nursing facility described in Probate Code section 2356.5(b). b. [-] The [] successor conservator of the person is granted authority to authorize the administration of medications appropriate for the care and treatment of dementia described in Probate Code section 2356.5(c) 29.["] Other orders as specified in attachment 29 are granted. 30. [] The probate referee appointed is (name and address): 31.["] (For limited conservatorship only) Orders relating to the powers and duties of the [__] successor limited conservator of the person under Probate Code section 2351.5 as specified in attachment 31 are granted. 32.{] (For limited conservatorship only) Orders relating to the powers and duties of the [_] successor limited conservator of the estate under Probate Code section 1830(b) as specified in attachment 32 are granted. 33.[-] (For limited conservatorship only) Orders limiting the civil and legal rights of the limited conservatee as specified in attachment 33 are granted 34.[-] This order is effective on the [] date signed (] date minor attains majority (specify): 35. Number of boxes checked in items 18-34 36. Number of pages attached Date: JUDICIAL OFFICER {] SiGnaTURE FOLLOWS LAST ATTACHMENT GE-340 [Rev, January 18. 2016} ORDER APPOINTING PROBATE CONSERVATOR Page 3013 (Probate—Guardianships and Conservatorships)

• __GC-350 ATTORNEY OR PARTY WITHOUT ATTORNEY (name, address, and State Bar number) After recording return to: TEL NO.: FAX NO. (optional): E-MAIL ADDRESS (optional). ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS STREET ADDRESS: 801 10TH STREET, 4TH FLOOR MAILING ADDRESS: 801 10TH STREET, 4TH FLOOR CITY AND ziP CODE: MODESTO, CA 95354 BRANCH NAME: FOR RECORDER'S USE ONLY CONSERVATORSHIP OF (name): CASE NUMBER: CONSERVATEE LETTERS OF CONSERVATORSHIP

|] Person []Estate {__] Limited Conservatorship FOR COURT USE ONLY

1. (Name): is the appointed ~] conservator [] limited conservator ofthe [] person [__] estate of (name):
2. [] (For conservatorship that was on December 31, 1980, a guardianship of an adult or of the person of a married minor) (Name): was appointed the guardian of the [] person [] estate by order dated (specify): and is now the conservator of the [_]} person {] estate of (name):
3. [—] Other powers have been granted or conditions imposed as follows: a. {]} Exclusive authority to give consent for and to require the conservatee to receive medical treatment that the conservator in good faith based on medical advice determines to be necessary even if the conservatee objects, subject to the limitations stated in Probate Code section 2356. (1) [__] This treatment shall be performed by an accredited practitioner of the religion whose tenets and practices call for reliance on prayer alone for healing of which the conservatee was an adherent prior to the establishment of the conservatorship. (2) {—} (/f court order limits duration) This medical authority terminates on (date): b. [—] Authority to place the conservatee in a care or nursing facility described in Probate Code section 2356.5(b). c. [] Authority to authorize the administration of medications appropriate for the care and treatment of dementia described in Probate Code section 2356.5(c). d. [-] Powers to be exercised independently under Probate Code section 2590 are specified in Attachment 3d (specify powers, restrictions, conditions, and limitations). e. [—] Conditions relating to the care and custody of property under Probate Code section 2402 are specified in Attachment 3e f. {} Conditions relating to the care, treatment, education, and welfare of the conservatee under Probate Code section 2358 are specified in Attachment 3f g. [] (For limited conservatorship only) Powers of the limited conservator of the person under Probate Code section 2351.5 are specified in Attachment 3g. h. [] (For limited conservatorship only) Powers of the limited conservator of the estate under Probate Code section 1830(b) are specified in Attachment 3h i. ([_“] Other powers granted or conditions imposed are specified in Attachment 3i ISEAL) 4. [] The conservator is not authorized to take possession of money or any other property without a specific court order.
4. Number of pages attached: WITNESS, clerk of the court, with seal of the court affixed.

| Date. | | Clerk, by _ ___, Deputy Page tof 2

This form may be recorded as notice of the establishment of a conservatorship of the estate as provided in Probate Code § 1875. a Form Adopted for M tory Use LETTERS OF CONSERVATORSHIP Probate Code §§ at Council of C 50 [Rev July 1 (Probate—Guardianships and Conservatorships) Code of Co #4

GC-350 CONSERVATORSHIP OF (name): CASE NUMBER: _CONSERVATEE NOTICE TO INSTITUTIONS AND FINANCIAL INSTITUTIONS (Probate Code sections 2890-2893) When these Letters of Conservatorship (Letters) are delivered to you as an employee or other representative of an institution or financial institution (described below) in order for the conservator of the estate (1) to take possession or conirol of an asset of the conservatee named above held by your institution (including changing title, withdrawing all or any portion of the asset, or transferring all or any portion of the asset) or (2) to open or change the name of an account or a safe-deposit box in your financial institution to reflect the conservatorship, you must fill out Judicial Council form GC-050 (for an institution) or form GC-051 (for a financial institution). An officer authorized by your institution or financial institution must date and sign the form, and you must file the completed form with the court. There is no filing fee for filing the form. You may either arrange for personal delivery of the form or mail it to the court for filing at the address given for the court on page 1 of these Letters. The conservator should deliver a blank copy of the appropriate form to you with these Letters, but it is your institution's or financial institution’s responsibility to complete the correct form, have an authorized officer sign it, and file the completed form with the court. If the correct form is not delivered with these Letters or is unavailable for any other reason, blank copies of the forms may be obtained from the court. The forms may also be accessed from the judicial branch’s public Web site free of charge. The Internet address (URL) is www.courts.ca.gov/forms/. Select the form group Probate—Guardianships and Conservatorships and scroll down to form GC-050 for an institution or form GC-051 for a financial institution. The forms may be printed out as blank forms and filled in by typewriter or may be filled out online and printed out ready for signature and filing. An institution under California Probate Code section 2890(c) is an insurance company, agent, or broker; an investment company; an investment bank; a securities broker-dealer; an investment advisor; a financial planner; a financial advisor; or any other person who. takes, holds, or controls an asset subject to a conservatorship or guardianship other than a financial institution. Institutions must file a Notice of Taking Possession or Control of an Asset of Minor or Conservatee (form GC-050) for an asset of the conservatee held by the institution. A single form may be filed for all affected assets held by the institution. A financial institution under California Probate Code section 2892(b) is a bank, a trust, a savings and loan association, a savings bank, an industrial bank, or a credit union. Financial institutions must file a Notice of Opening or Changing a Guardianship or Conservatorship Account or Safe-Deposit Box (form GC-051) for an account or a safe-deposit box held by the financial institution. A single form may be filed for all affected accounts or safe-deposit boxes held by the financial institution. LETTERS OF CONSERVATORSHIP AFFIRMATION 1 solemnly affirm that | will perform according to law the duties of conservator [] limited conservator. Executed on (date): , at (place): (TYPE OR PRINT NAME) (SIGNATURE OF APPOINTEE) CERTIFICATION

| certify that this document, including any attachments, is a correct copy of the original on file in my office, and that the Letters issued to

the person appointed above have not been revoked, annulled, or set aside, and are still in full force and effect Date: Clerk, by . , Deputy GC-360 {Rev. July 1, 2015) LETTERS OF CONSERVATORSHIP Page 2 of? (Probate—Guardianships and Conservatorships)