San Benito — SB-PR-3

Source: https://www.sanbenito.courts.ca.gov/system/files/sbpr3.pdf

SB‐PR‐3 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 SAN BENITO 450 Fourth Street Hollister, CA 95023

CONSERVATORSHIP OF:

CONSERVATEE
PETITION FOR REAPPOINTMENT OF CONSERVATORSHIP CASE NUMBER:
OF THE PERSON AND ESTATE
WELFARE & INSTITUTIONS CODE §5361

PETITIONER (name): ALLEGES THAT:

1. This Court appointed Petitioner the conservator of the person and estate of the conservatee (name):

   on (date):

2. Letters of conservatorship were issued to Petitioner on (date):

3. Petitioner is the duly appointed, qualified, and acting conservator of the person and estate of the conservatee and has been since the date of issuance of the letters.

4. Petitioner has determined that the conservatorship is still required because the conservatee is still gravely disabled as a result of mental disorder or chronic alcoholism.

5. Petitioner's determination is supported by the written opinions of the following duly licensed

   physician(s) and/or clinical psychologist(s). These opinions state, in effect, that the conservatee is still gravely disabled as a result of mental impairment and/or chronic alcoholism. The names and addresses of the physician(s) and/or clinical psychologist(s) are:

   Physician Clinical Psychologist Physician Clinical Psychologist

These opinions are attached as Exhibits and made a part of this petition.

6. Petitioner is unable to obtain the opinion of two physicians or licensed psychologists that the conservatee is still gravely disabled as a result of mental impairment and/or chronic alcoholism. Petitioner therefore

   requests that this Court appoint two physicians or licensed clinical psychologists for this purpose, under the provisions of Welfare and Institutions code § 5361.

7. Under the provisions of Welfare and Institutions code §§ 5361 and 5368, if Petitioner is not reappointed conservator, the conservatorship will automatically terminate on (date):

Form Adopted for OPTIONAL USE PETITION FOR REAPPOINTMENT Page 1 of 3 Superior Court of San Benito OF CONSERVATOR Welfare & Institutions Code §5361 SB‐PR‐3

CONSERVATORSHIP OF: CASE NUMBER: CONSERVATEE

8. On reestablishment of the conservatorship, the following rights and privileges enumerated in Welfare and Institutions Code §5357 should be denied to the conservatee:

   a. the privilege of possessing a license to operate a motor vehicle; b. the right to enter into a contract; c. the right to vote; d. the right to enter into the following types of transactions (specify): e. the right to enter into transactions that are in excess of (specify): $ f. the right to refuse treatment related specifically to the conservatee’s grave disability; g. the right to refuse routine medical treatment that is unrelated to the proposed conservatee’s grave disability; h. the right to possess a firearm.

WHEREFORE, PETITIONER REQUESTS THAT:

1. Petitioner (name): be reappointed as conservator of the person and estate of the conservatee for a succeeding one‐year period beginning (date): and ending (date):

2. This Court appoint two physicians or licensed clinical psychologists pursuant to Welfare and Institutions

   Code §5361 for the purpose of determining if the conservatee is still gravely disabled.

3. Conservator shall have the same powers that are/were granted to the conservator on the previous

   appointment by the Court.

4. The conservatee shall be denied: a. the privilege of possessing a license to operate a motor vehicle; b. the right to enter into a contract; c. the right to vote; d. the right to enter into the following types of transactions (specify): e. the right to enter into transactions that are in excess of (specify): $ f. the right to refuse treatment related specifically to the conservatee’s grave disability; g. the right to refuse routine medical treatment that is unrelated to the proposed conservatee’s grave disability; h. the right to possess a firearm.

5. Other relief be granted that the Court considers proper.

Date:

(TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER)

Form Adopted for OPTIONAL USE PETITION FOR REAPPOINTMENT Page 2 of 3 Superior Court of San Benito OF CONSERVATOR Welfare & Institutions Code §5361 SB‐PR‐3

CONSERVATORSHIP OF: CASE NUMBER: CONSERVATEE

VERIFICATION

I am the petitioner in this action. I have read the foregoing Petition for Reappointment of Conservator of the Person and Estate and know the contents thereof. I certify that the same is true of my own knowledge. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Executed on (date): , at (city): , California.

(TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER)

Form Adopted for OPTIONAL USE PETITION FOR REAPPOINTMENT Page 3 of 3 Superior Court of San Benito OF CONSERVATOR Welfare & Institutions Code §5361 SB‐PR‐3