Santa Cruz — SUPPR-1085

Source: https://www.santacruz.courts.ca.gov/sites/default/files/pdfs/POST%20%28WEB%29SUPPR%201085%20Referral%20to%20Court%20Investigator%20CONFIDENTIAL.pdf

SUPPR 1085 ATTORNEY OR PARTY WITHOUT AN ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY NAME: ADDRESS: CITY, STATE, ZIP:

TELEPHONE NO: FAX NO. (Optional): EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA COUNTY OF SANTA CRUZ 701 Ocean Street, Room 110 Santa Cruz, CA 95060 Santa Cruz Branch Conservatorship Person Estate of

REFERRAL TO COURT INVESTIGATOR CASE NUMBER:
CONFIDENTIAL

Complete and file with initial petition, each accounting, and when any party changes residence. Note: A fee may be assessed for Court Investigator Services – See Probate Code §1851.5

Hearing Date: ____________________________

This referral is being sent to the Probate Investigator’s Office for an investigation regarding (check all that apply): Appointment Accounting/Review Termination Medical Powers Major Neurocognitive Disorder Powers Substituted Judgment Sale of (former) Residence Other: (Specify)

Information about the (Proposed) CONSERVATEE (Proposed) Conservatee’s CURRENT address: Address: _______________________________________________________________________________________________ Phone number: _________________________ (Proposed) Conservatee’s HOME address: Address: _______________________________________________________________________________________________ Phone number: _________________________ Birth Date: _____________________________ Social Security Number: _____________________________ Marital Status: Single/Divorce Widowed Married Registered Domestic Partner

Special Needs (i.e. language)? _________________________________ Is (proposed) conservatee under an LPS Conservatorship? Yes No If yes, LPS # (Proposed) Conservatee’s Attorney (name): _________________________________________________________ Address: ______________________________________________________________________________________________ Phone number: _________________________________ Fax number: ____________________________________ Email: _________________________________________ (The reverse side may be used for additional information, if desired)

Form Adopted for MANDATORY USE REFERRAL TO COURT INVESTIGATOR – Page 1 of 3 Superior Court of Santa Cruz County CONFIDENTIAL (PROBATE)SUPPR 1085 01/01/20

CONSERVATORSHIP OF (NAME): CASE NUMBER:

Information about the (Proposed) CONSERVATOR

All proposed Conservators must complete the information on this page. If there is more than one proposed Conservator, attach a copy of this page for each person.

Person Estate

Name:

Address:

Daytime Phone:

Relationship to Conservatee/ward:

Date of Birth:

Social Security Number:

Driver’s License Number:

Work Phone:

Cell Phone:

Attorney:

Attorney’s Address:

Attorney’s Fax:

Email:

I declare under penalty of perjury under the laws of the State of CaliforniaSIGN that the foregoing is true and correct.

________________________________ _______________________________________
Date Signature of Proposed Conservator

Information sheet(s) for (number) ______________ of (proposed) co-conservators is attached.

Form Adopted for MANDATORY USE REFERRAL TO COURT INVESTIGATOR – Page 2 of 3 Superior Court of Santa Cruz County CONFIDENTIAL (PROBATE)SUPPR 1085 01/01/20

CONSERVATORSHIP OF (NAME): CASE NUMBER:

Information about the (Proposed) Conservatee’s Relatives & Friends:

List the spouse or registered domestic partner, 1 st and 2 nd degree relatives (these are parents, children, brothers/sisters, grandparents and grandchildren), neighbors and close friends of the (proposed) conservatee.

Name: ______________________________________________________________________________________ Relationship to (proposed) Conservatee:______________________ Email: _______________________________ Home Address: _______________________________________________________________________________ Home Phone:______________________ Work Phone: ______________ ______ Cell Phone: _________________

Name: ______________________________________________________________________________________ Relationship to (proposed) Conservatee:______________________ Email: _______________________________ Home Address: _______________________________________________________________________________ Home Phone:______________________ Work Phone: ______________ ______ Cell Phone: _________________

Name: ______________________________________________________________________________________ Relationship to (proposed) Conservatee:______________________ Email: _______________________________ Home Address: _______________________________________________________________________________ Home Phone:______________________ Work Phone: ______________ ______ Cell Phone: _________________

Name: ______________________________________________________________________________________ Relationship to (proposed) Conservatee:______________________ Email: _______________________________ Home Address: _______________________________________________________________________________ Home Phone:______________________ Work Phone: ______________ ______ Cell Phone: _________________

Name: ______________________________________________________________________________________ Relationship to (proposed) Conservatee:______________________ Email: _______________________________ Home Address: _______________________________________________________________________________ Home Phone:______________________ Work Phone: ______________ ______ Cell Phone: _________________

Name: ______________________________________________________________________________________ Relationship to (proposed) Conservatee:______________________ Email: _______________________________ Home Address: _______________________________________________________________________________ Home Phone:______________________ Work Phone: ______________ ______ Cell Phone: _________________

Name: ______________________________________________________________________________________ Relationship to (proposed) Conservatee:______________________ Email: _______________________________ Home Address: _______________________________________________________________________________ Home Phone:______________________ Work Phone: ______________ ______ Cell Phone: _________________

Form Adopted for MANDATORY USE REFERRAL TO COURT INVESTIGATOR – Page 3 of 3 Superior Court of Santa Cruz County CONFIDENTIAL (PROBATE)SUPPR 1085 01/01/20