Kern — KRN SUP CRT MC-2478

Source: https://www.kern.courts.ca.gov/system/files/appointment-termination-or-resignation-supporter-krn-sup-crt-mc-2478.pdf

KRN SUP CRT MC-2478 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address) FOR COURT USE ONLY

TELEPHONE NO: FAX NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR(Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF KERN STREET ADDRESS: 1215 Truxtun Avenue CITY AND ZIP CODE: Bakersfield, CA 93301 BRANCH NAME: Metropolitan Justice Building CARE ACT PROCEEDING FOR: CASE NUMBER:

APPOINTMENT, TERMINATION OR RESIGNATION OF SUPPORTER

Note: The respondent may use this form to appoint a supporter with access to the court’s file in this case, or terminate the authority of the supporter. The supporter may also use this form to resign.

1. Respondent’s name: _________________________________________________________________________
2. This document concerns the following individual: a. Name: __________________________________________ Telephone: _____________________ b. Address: _______________________________________________________________________ c. Email:Email: __________________________________________________________________________
3. Respondent: a. Appointment: I appoint the person at item 2 as my supporter. b. Health Records and Court File (1) Granted: As my supporter, the person at item 2 can receive documents and information with protected health information and mental health records (excluding psychotherapy notes) from the county behavioral health agency and can inspect the court’s file in the CARE Act proceeding. (2) Denied: The person at item 2 cannot receive documents and information with protected health information and mental health records from the county behavioral health agency, or inspect the court’s file in the CARE Act proceeding. c. Termination: The person at item 2 is no longer my supporter.

4. The person at item 2 hereby resigns as supporter.

   SIGN

Dated: ___________________________________________ (SIGNATURE OF SUPPORTER) Dated:

SIGN

(TYPE OR PRINT NAME OF RESPONDENT’S ATTORNEY) (SIGNATURE OF RESPONDENT’S ATTORNEY)

SIGN

(TYPE OR PRINT NAME OF RESPONDENT) (SIGNATURE OF RESPONDENT)

APPOINTMENT, TERMINATION OR RESIGNATION OF SUPPORTER

KRN SUP CRT MC-2478 [Adopted on 10/01/2024] Optional Form