Santa Clara — PB-4003-1a*

Source: https://santaclara.courts.ca.gov/system/files/forms/pb-4003-1a_rem.pdf

ATTACHMENT PB-4003-1a SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA FOR COURT USE ONLY COURT ADDRESS: 191 North First Street To keep other people from CITY AND ZIP CODE: San José, California 95113 seeing what you have entered, PHONE NUMBER: (408) 882-2761 please press the Reset Form FAX NUMBER: (408) 882-2797 button at the end of this form BRANCH NAME: Downtown Courthouse – Court Investigator’s Division when finished. IN THE MATTER OF THE Limited Conservatorship Conservatorship

RE:

CASE NUMBER:

CONFIDENTIAL DOCUMENT COVER SHEET (Conservatorship - CSF)

RE: CONSERVATORSHIP:

The following documents shall be made available only to persons who have been designated by the Court to assist the Court in determining whether a proposed conservator should be appointed.

Cal. Rules of Court, Rule 7.1050: Confidential Conservator Screening Form.

Other:

Reset Form

PB-4003-1a REV 07/01/10 CONFIDENTIAL DOCUMENT COVER SHEET Page 1 of 1 (Conservatorship - CSF)