Confidential Supplemental Information (Probate Conservatorship) {GC-312}

CONFIDENTIAL (DO NOT ATTACH TO PETITION) ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): FOR COURT USE ONLY GC-312 TELEPHONE NO.: E­MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CONSERVATORSHIP OF (Name): PROPOSED CONSERVATEE CONFIDENTIAL SUPPLEMENTAL INFORMATION Conservatorship of (Probate Conservatorship) Person Estate Limited Conservatorship CASE NUMBER: HEARING DATE: 1. a. Proposed conservatee (name): b. Date of birth: c. Social security No.: 2. DEPT.: TIME: UNABLE TO PROVIDE FOR PERSONAL NEEDS* The following facts support petitioner's allegation that the proposed conservatee is unable to provide properly for his or her needs for physical health, food, clothing, and shelter (specify in detail, enlarging upon the reasons stated in the petition; provide specific examples from the proposed conservatee's daily life Specified in Attachment 2. showing significant behavior patterns): * If this item is not applicable, complete item 8. (Continued on reverse) Form Adopted for Mandatory Use Judicial Council of California GC-312 [Rev. January 1, 2001] Page one of four Probate Code, § 1821 CONFIDENTIAL SUPPLEMENTAL INFORMATION (Probate Conservatorship) 2001 © American LegalNet, Inc. CONFIDENTIAL CONSERVATORSHIP OF (Name): PROPOSED CONSERVATEE CASE NUMBER: 3. UNABLE TO MANAGE FINANCIAL RESOURCES* The following facts support petitioner's allegation that the proposed conservatee is substantially unable to manage his or her financial resources or to resist fraud or undue influence (specify in detail, enlarging upon the reasons stated in the petition; provide specific examples from the proposed conservatee's daily life showing significant behavior patterns): Specified in Attachment 3. 4. RESIDENCE ("Residence" means the place usually described as "home"; for example, owned real property or long-term rental.) a. The proposed conservatee is located at (street address, city, state): b. The proposed conservatee's residence is* the address in item 4a other (street address, city, state): c. Ability to live in residence* The proposed conservatee is (1) living in his or her residence and (a) will continue to live there unless circumstances change. (b) will need to be moved after a conservator is appointed (specify supporting facts below in item 4c(3)). (c) other (specify and give supporting facts below in item 4c(3)). * If this item is not applicable, complete item 8. (Continued on page three) GC-312 [Rev. January 1, 2001] CONFIDENTIAL SUPPLEMENTAL INFORMATION (Probate Conservatorship) Page two of four 2001 © American LegalNet, Inc. CONFIDENTIAL CONSERVATORSHIP OF (Name): PROPOSED CONSERVATEE CASE NUMBER: 4. c. (continued) (2) not living in his or her residence and (a) will return by (date): (specify supporting facts below in item 4c(3)). (b) will not return to live there (specify supporting facts below in item 4c(3)). (c) other (specify and give supporting facts below in item 4c(3)). (3) Supporting facts (specify if required): Specified in Attachment 4c. 5. ALTERNATIVES TO CONSERVATORSHIP* Petitioner has considered the following alternatives to conservatorship and found them to be unsuitable or unavailable to the proposed conservatee (specify the alternatives considered and the reason or reasons each is unsuitable or unavailable): Reasons specified in Attachment 5. a. Voluntary acceptance of informal or formal assistance (give reason this is unsuitable or unavailable): b. Special or limited power of attorney (give reason this is unsuitable or unavailable): c. General power of attorney (give reason this is unsuitable or unavailable): d. Durable power of attorney for health care estate management (give reason this is unsuitable or unavailable): e. Trust (give reason this is unsuitable or unavailable): f. Other alternatives considered (specify and give reason each is unsuitable or unavailable): 6. SERVICES PROVIDED* (complete a or b, or both a and b) a. During the year before this petition was filed, were provided were not provided (1) health services Explained in Attachment 6a(1). to the proposed conservatee (explain): were provided (2) social services Explained in Attachment 6a(2). were not provided to the proposed conservatee (explain): * If this item is not applicable, complete item 8. (Continued on page four) GC-312 [Rev. January 1, 2001] CONFIDENTIAL SUPPLEMENTAL INFORMATION (Probate Conservatorship) Page three of four 2001 © American LegalNet, Inc. CONFIDENTIAL CONSERVATORSHIP OF (Name): PROPOSED CONSERVATEE CASE NUMBER: 6. a. (continued) (3) estate management assistance conservatee (explain): Explained in Attachment 6a(3). was provided was not provided to the proposed b. Petitioner has no knowledge of what health services estate management social services assistance was provided to the proposed conservatee during the year before this petition was filed. Petitioner has no reasonable means of determining what services were provided. 7. SUPPORTING FACTS (AFFIDAVITS) The information provided above is stated in an affidavit (declaration) by another person attached as Attachment 1a. a. Item 1: on petitioner's own knowledge in an affidavit (declaration) by another person attached as Attachment 2a. on petitioner's own knowledge b. Item 2: in an affidavit (declaration) by another person attached as Attachment 3a. on petitioner's own knowledge c. Item 3: in an affidavit (declaration) by another person attached as Attachment 4a. on petitioner's own knowledge d. Item 4: in an affidavit (declaration) by another person attached as Attachment 5a. on petitioner's own knowledge e. Item 5: in an affidavit (declaration) by another person attached as Attachment 6a. on petitioner's own knowledge f. Item 6: 8. ITEMS NOT APPLICABLE The following items on this form were not applicable to the proposed conservatee: 2 3 4b 4c 5 6 (specify reasons each item is not applicable): Reasons specified in Attachment 8. 9. Number of pages attached: _____ DECLARATION I declare 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) GC-312 [Rev. January 1, 2001] CONFIDENTIAL SUPPLEMENTAL INFORMATION (Probate Conservatorship) Page four of four 2001 © American LegalNet, Inc.