Nevada — Information

Source: http://nccourt.net/forms/packets/Conservatorship%20Investigator%20Info%20Sheet.pdf

Name, Address and Telephone Number 1 Of Petitioner or Attorney: 2

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6 SUPERIOR COURT OF THE STATE OF CALIFORNIA 7 COUNTY OF NEVADA 8

9 Conservatorship of the ___ Person _____ Estate

10 Name: ___________________________________________________________________11 Court Investigator Information/ Status Report Case Number: 12 Conservatee: Date of birth: 13 Name: ___________________________________________________________________14

15 Address: __________________________ City: __________________________________

16 State and Zip Code: ________________________________________________________

17 Phone number: _________________________ Marital Status: _____________________

18 Physician: ________________________ Phone Number: _________________________

19 Date of Last Exam: ________________________________________________________ 20 Attends School/ Program(s): ______ Yes ________ No 21 School/Program Name, Address & Telephone Number, (include case worker’s name): 22

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25 _________________________________________________________________________

26 Program/School Schedule: __________________________________________________

27 __________________________________________________________________________

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Conservatee’s Caregiver’s Name: ___________________________________________ 1 Address: __________________________ City: _________________________________ 2

State and Zip Code: _______________________________________________________ 3

4 Phone number: _________________________

5 Conservatee’s Attorney’s Name: ___________________________________________

6 Address: __________________________ City: ________________________________

7 State and Zip Code: ______________________________________________________ 8 Phone number: _________________________ 9 Conservator: 10 Conservator’s Name: _____________________________________________________ 11 Address: __________________________ City: ________________________________ 12 State and Zip Code: ______________________________________________________13

Phone number: _________________________14

15 Conservator’s Attorney’s Name: ___________________________________________

16 Address: __________________________ City: ________________________________

17 State and Zip Code: ______________________________________________________

18 Phone number: _________________________ 19 State any other information you believe should be available to the court investigator 20 regarding the well-being of the Conservatee: 21 __________________________________________________________________________ 22 __________________________________________________________________________ 23 __________________________________________________________________________24

__________________________________________________________________________25

26 __________________________________________________________________________

27 __________________________________________________________________________

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1 Conservatee’s close relatives, spouse/domestic partner, close friends and neighbors: 2

Name: _________________________________________________________________ 3

4 Address: ________________________________________________________________

5 ________________________________________________________________________

6 (Also include business address if needed for contact)

7 Telephone number: _______________________________________________________ 8 (Also include business telephone number if needed for contact) 9 Relationship to Conservatee: ______________________________________________ 10 Name: __________________________________________________________________ 11 Address: ________________________________________________________________ 12 ________________________________________________________________________13

(Also include business address if needed for contact)14

15 Telephone number: _______________________________________________________

16 (Also include business telephone number if needed for contact)

17 Relationship to Conservatee: _______________________________________________

18 Name: __________________________________________________________________ 19 Address: ________________________________________________________________ 20 ________________________________________________________________________ 21 (Also include business address if needed for contact) 22 Telephone number: ______________________________________________________ 23 (Also include business telephone number if needed for contact)24

Relationship to Conservatee: ______________________________________________25

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Name: _________________________________________________________________ 1 Address: _______________________________________________________________ 2

_______________________________________________________________________ 3

4 (Also include business address if needed for contact)

5 Telephone number: ______________________________________________________

6 (Also include business telephone number if needed for contact)

7 Relationship to Conservatee: ______________________________________________ 8 Name: _________________________________________________________________ 9 Address: _______________________________________________________________ 10 _______________________________________________________________________ 11 (Also include business address if needed for contact) 12 Telephone number: ______________________________________________________13

(Also include business telephone number if needed for contact)14

15 Relationship to Conservatee: _______________________________________________

16 Name: __________________________________________________________________

17 Address: ________________________________________________________________

18 ________________________________________________________________________ 19 (Also include business address if needed for contact) 20 Telephone number: _______________________________________________________ 21 (Also include business telephone number if needed for contact) 22 Relationship to Conservatee: _______________________________________________ 23 (Attach additional pages as needed)24

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26 This form was completed by:

27 Dated:____________________________________________________________________

28 (Please print name, sign and date)

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