Marin — PR036

Source: https://www.marin.courts.ca.gov/system/files/pr036-fiduciaryfeedeclarationn1-14n-1.pdf

Name, address and telephone number(s): FOR COURT USE ONLY

MARIN COUNTY SUPERIOR COURT 3501 Civic Center Drive P.O. Box 4988 San Rafael, CA 94913-4988 GUARDIANSHIP CONSERVATORSHIP TRUST

FOR: CASE NUMBER: FIDUCIARY FEE DECLARATION

I, _______________________________________________, declare as follows:

1. I am the ______________________________________________ (identifying information). I have personal

knowledge of the facts set forth in this declaration, and offer it in support of my request for payment of $_____________ to me as fees for services that I have provided (including time spent by declarant’s assistants). This request is for the period beginning ________________ and ending _. I am also requesting approval of reimbursement for out-of-pocket expenses in the amount of $, of which $_____________ has already been reimbursed.

2. Rates for Services Charged. Declarant’s normal billing rate is $__________ /hour. Declarant has staff that assists with services related to the conservator of the person and estate. Staff time is billed at $__________ /hour. Services provided by staff included:

   .

3. Summary of Time Categories / Fees. This declaration describes services provided by declarant (and any assistants). A total of _________ hours of services were provided, broken down as follows:

   Total Hours Hourly Rate Total Fees

   a. Conservator / guardian of the person by declarant: Hrs $ $ b. Conservator / guardian / trustee of the estate by declarant: Hrs $ $ c. Conservator / guardian of the person by assistant: Hrs $ $ d. Conservator / guardian / trustee of the estate by assistant: Hrs $ $ e. Travel time by declarant: Hrs $ $ f. Travel time by assistant: Hrs $ $

   TOTAL FEES: $

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GUARDIANSHIP CONSERVATORSHIP TRUST CASE NUMBER:

FOR:

4. Summary of Services Provided. The services for which I am now seeking compensation are summarized as follows (provide attachment, if needed):

   a. Services prior to appointment:

   b. Initial petition:

   c. Temporary petition and powers:

   d. General administration (e.g., marshaling assets, preparation of the I&A, bill-paying, account reconciliation, investment decisions, accounting, fee declaration):

   e. Conservatee’s personal care. Who is providing the care? Who is supervising the care?

   f. Change in residence:

   g. Conservatee’s healthcare:

   h. Conservatee’s family and friends:

   i. Contested or complex issues:

   j. Management of real property or business:

   k. Sale of residence:

   l. Substituted judgment / petition for instructions:

   m. Agents hired / disclosure of relationships (if the conservator provided a service directly rather than hiring an agent, discuss the basis for this decision):

5. Declarant’s Travel Policy:

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6. Reimbursement of Out-of-Pocket Expenses:

7. Conclusion (include a discussion of the factors in California Rule of Court 7.756):

I declare under penalty of perjury that the foregoing is true and correct and that this declaration was executed on _____________________ in _______________________________, California.

DATE SIGNATURE

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