San Diego — Fee Declaration: Conservator Person - Estate PR-096 (Rev: 09/15)

Source: https://www.sdcourt.ca.gov/sites/default/files/sdcourt/generalinformation/forms/probateforms/pr096.pdf

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

TELEPHONE NO.: FAX NO. (Optional):

EMAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, CENTRAL COURTHOUSE, 1100 UNION ST., SAN DIEGO, CA 92101 CENTRAL DIVISION, MADGE BRADLEY, 1409 4TH AVE., SAN DIEGO, CA 92101 CONSERVATORSHIP OF

CASE NUMBER
FEE DECLARATION: CONSERVATOR
Person Estate

Instructions: A fee declaration is required when fees are requested by a Conservator of the Person and/or Estate. The declaration must be filled out completely and attachments should be used where additional space is needed. This form should not be used for Guardianships, Decedent’s Estates or Trust matters.

1. IDENTITY OF PARTIES/GENERAL INFORMATION This section must be completed for all fee requests (person and estate).

   a. Conservatee: b. Conservator: c. Conservator’s relationship to conservatee: Registered Private Professional Conservator Family Member/Relative Other:

   d. If filing as a Private Professional Conservator, state your years of experience: e. Description of your experience, specialized training, and education that contributes to your expertise as a fiduciary: Continued on Attachment 1e. f. Reporting period for this fee request: g. Number of months in this reporting period:

2. CONSERVATOR OF THE PERSON This section must be completed if you are seeking compensation as a conservator of the person.

   a. Type of residence of conservatee: Own home or apartment Retirement facility Assisted living facility Board and care Skilled nursing facility Other:

   b. Conservatee’s ability to perform activities of daily living: With Yes No Assistance Comments: Ambulation Transferring (bed to chair) Personal hygiene Dressing Feeding

SDSC PR-096 (Rev. 9/15) FEE DECLARATION: CONSERVATOR Page 1 of 3 Person - Estate

IN THE CONSERVATORSHIP OF CASE NUMBER

c. With respect to services provided during the accounting period for which the conservator of the person is
requesting compensation, complete the following table:

Level of Nature of Services Total Hourly Category Difficulty Total Fee & Results Achieved (High, Medium, Low) Hours Rate
Communication with Legal
Counsel
Communication with
Family/Friends
Arrangements for Living
Situation / Residency (Including
meals, clothing, personal care,
housekeeping, and recreation)
Health Care
Transportation
Recreation
Other
Totals

d. Previous Reporting Period: Current Reporting Period:
1. Fees for services approved and paid: 1. Fees for services:
2. Hours for services approved and paid: 2. Hours for services:
3. Average monthly fee for services: 3. Average monthly fee for services:

Total fees: Total fees:
Total hours: Total hours:

e. If, during the accounting period, a person or company assisted in monitoring the care of the conservatee,
complete the following:

Name of Hired Agent(s) Function(s)

Continued on Attachment 2e.

3. CONSERVATOR OF THE ESTATE This section must be completed if you are seeking compensation as conservator of the estate.

   a. With respect to services provided during the accounting period for which the conservator of the estate is requesting compensation, complete the following table: Level of Nature of Services Total Hourly Category Difficulty Total Fee & Results Achieved (High, Medium, Low) Hours Rate Estate Administration (collecting income, paying bills, reconciling bank statements, etc.) Communication with Legal Counsel Asset Management Preparation of Court Accounting Preparation of Fee Declaration

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IN THE CONSERVATORSHIP OF CASE NUMBER

Level of Nature of Services Total Hourly Category Difficulty Total Fee & Results Achieved (High, Medium, Low) Hours Rate
Income Tax Return Compilation
Management of Caregivers
Health Care Issues
Marshalling Assets
Termination of Proceedings
Participation in Appointment
Proceeding
Sale of Assets
Income Tax Return Preparation
Litigation
Tenancy Issues
Other
Totals
Total Fee Request for Conservator of Estate

b. Previous Reporting Period: Current Reporting Period:
1. Fees for services approved and paid: 1. Fees for services:
2. Hours for services approved and paid: 2. Hours for services:
3. Average monthly fee for services: 3. Average monthly fee for services:

Total fees: Total fees:
Total hours: Total hours:

c. If, during the accounting period, a person or company performed routine accounting services other than income
tax preparation and was compensated by the estate, complete the following:

Name of Hired Agent(s) Function(s)

Continued on Attachment 3c.

I 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 Conservator Signature of Conservator

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