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Referral Information And List Of Relatives (Confidential) (Probate Conservatorship) PR-020 - California
| Referral Information And List Of Relatives (Confidential) (Probate Conservatorship) Form. This is a California form and can be used in Probate San Diego Local County . |
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CONFIDENTIAL ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO.(Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, MADGE BRADLEY, 1409 4TH AVE., SAN DIEGO, CA 92101 CONSERVATORSHIP OF PERSON ESTATE LIMITED CONSERVATORSHIP OF JUDGE/DEPT APPOINTMENT ACCOUNTING OTHER HEARING DATE REFERRAL INFORMATION AND LIST OF RELATIVES (CONFIDENTIAL) TO BE COMPLETED BY THE PETITIONER 1. (Proposed) Conservatee: Name: CASE NUMBER Address: _______________________________________ (Gate/Door Code): ___________ Zip Code: Tel. No.: ___________________________________ Contact Person: Is there an LPS conservatorship? Yes No (If yes, list case number, name & address of LPS conservator) Is (proposed) conservatee a Medi-Cal recipient? Yes No 2. Information for the Court Investigator (to be completed by the petitioner): A. Special Circumstances: Primary language spoken: English Spanish other: Communication issues: non-verbal aphasia other: Any other barriers to investigation/meeting with the conservatee that the investigator should be aware of: B. Safety/Hazards: health hazards paranoia unpredictable aggressive firearms dogs drugs gangs restraining orders (list case number and court location): threatening behavior other: 3. Name of facility or program: This section is to be completed if the conservatee is always or frequently at another location between the hours of 8:00 a.m. and 5:00 p.m., Monday through Friday. Name: ___________________________________________ Type of Facility/Program: Address: _______________________________________________________ Zip Code: Tel. No.: ___________________________________ Contact Person: SDSC PR-020 (Rev. 9/12) REFERRAL INFORMATION AND LIST OF RELATIVES (CONFIDENTIAL) Prob. Code § 1826 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL CONSERVATORSHIP OF (Name): CASE NUMBER 4. (Proposed) Conservator: Name: _____________________________________________ Relationship: Address: _______________________________________________________ Zip Code: Tel. No.: __________________ Work: _________________ Fax: _________________ Cell No.: 9. (Proposed) Conservatee's Physician/Practitioner: Name: Institution (if applicable): Address: _______________________________________________________ Zip Code: Tel. No.: _________________________________________ Fax: LIST OF CONSERVATEE'S RELATIVES/FRIENDS: List conservatee's spouse or registered domestic partner, 1st degree relatives (parents and children), 2nd degree relatives (brothers and sisters, grandparents and grandchildren), neighbors, and, if known, conservatee's close friends. Name: __________________________________________ Relationship: ___________________________________ Address: _______________________________________________________ Zip Code: _______________________ Home Tel. No.: ______________________________ Work Tel. No.: __________________________________ Name: __________________________________________ Relationship: ___________________________________ Address: _______________________________________________________ Zip Code: _______________________ Home Tel. No.: ______________________________ Work Tel. No.: __________________________________ See attachment for additional relatives/friends. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Type or Print Name Signature of Petitioner SDSC PR-020 (Rev. 9/12) REFERRAL INFORMATION AND LIST OF RELATIVES (CONFIDENTIAL) Prob. Code § 1826 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com
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