raising autism header

P74 General Plan for Personal and Financial Needs of Conservatee



Straightforward form that is easy to fill out especially if the conservatee has little in the way of assets. This is usually the case for someone just turning 18 or on SSI.

Your initial filing must be within 60 days of the date of the court’s order appointing you as conservator(s) which is the date stamped on GC-340 Order Appointing Probate Conservator. This form is filed along with GC-355 Determination of Conservatee’s Appropriate Level of Care. Likewise, you will file this form on a yearly basis with the court.

Form Links

Filled in Example p74 Form

- You can edit the example Doe forms to your situation, print, and file it at your local California Superior Court. The form is the same as the one you can get from a California Superior Court Website.

Blank p74 Form

http://www.courts.ca.gov/forms.htm?filter=GC California Probate Conservatorship Complete List Downloadable

Content

The each page notes are below the respective image of the form page.

Form P74 Page 1 Notes

Form P74 Page 2 Notes

Form P74 in HTML so it can be Translated

form p74 page 1

Page 1 Notes

Fill the form out for your situation.

I note that eventually a young adult with disabilities that needs conservatorship will most likely need some supportive living situation throughout their lives.

Top
p74 page 2

Page 2 Notes

Fill the form out for your situation.

Do not forget to date and sign the form at the bottom.

Top

P74 Form in HTML so it can be Translated

The P74 form is reproduced here in html so that it can easily be translated into multiple languages. You can not use this form to submit to court in any language. You have to use the P74 pdf form and English.


For Court use only
















Attorney:

Name                                                         

Address                                                         

                                                        


Phone                                                         


Conservator(s)

 John Doe                                         

 Jane Doe                                         

SUPERIOR COURT OF CALIFORNIA
COUNTY OF SAN FRANCISCO
400 McALLISTER, ROOM 103
SAN FRANCISCO, CA 94102-4512

CONSERVATORSHIP OF small form box check PERSON  small form box ESTATE  small form box check LIMITED CONSERVATORSHIP   Case No.  PCN-16-123456       
 Terry Morgan Doe                                                       
General Plan for Personal and Financial Needs of Conservatee
Confidential

All questions on the form must be completed and answered. If the question or blank does not apply, write “not applicable” or “none”. If you need additional space to fully respond, please note on the form that a separate attachment is being provided and staple the attachment to the form.

PERSONAL NEEDS
Living Arrangements
Current address of Conservatee                                                                            Phone:   415-123-4567     
                                                                              
(Include name of facility if appropriate)

Current living arrangement:
small form box check Personal residence  small form box Home of relative  small form box Board and care home  small form box Assisted living small form box Skilled nursing facility

The Conservatee has been at the present residence since  1/2/1998   .

If the Conservatee is in his or her personal residence, what is the current level of care?

small form box No assistance needed at this time.
small form box Household help                            Hours per week
small form box check Personal caregivers              70     Hours per week

What will be necessary to keep the Conservatee in his/her personal residence?
Parents health and the ability of personal caregivers to come in. Eventually the conservatee will need to live in a group home situation                                                                                               

If the Conservatee is not living in his/her personal residence:

What is the plan to return the Conservatee to his or her personal residence?





If there are no plans to return the Conservatee to his/her personal residence in the foreseeable future, explain the limitations or restrictions for not doing it.

Terry is autistic and mentally retarded. Terry will need support throughout Terry's life. Terry will require a group home facility.

Medications
Name Purpose of Medication   Name Purpose of Medication
clonidine 0.1 mg disruptive behavior      
colace 100mg and miralax 1 T constipation      
lithium carbonate 500mg mood stabilizer      
Vitamin D3 1000 units supplement      

Form P74 GENERAL PLAN FOR PERSONAL AND FINANCIAL NEEDS OF CONSERVATEE
CONFIDENTIAL
1




Visitations
How often do you visit the Conservatee?   Live with                                                                             
How often does the Conservatee receive visits from family and friends?   3 times a week                                          
Are any visitations particularly valued or upsetting to the Conservatee?   Parents are both valued and can be upsetting                  

Activities

Describe the normal activities of Conservatee.
small form box check   Outings   with parents and personal caregiver                                                                                
small form box check   Television / Radio   when desired                                                                                                
small form box check   Social   Day program                                                                                                                   
small form box check   Educational   currently going to school                                                                                         
small form box check   Recreational   walking, computer, music, riding transportation                                                        
small form box   Unwilling to participate                                                small form box    Unable to participate                      
small form box   Other (i.e. reading material) Describe:                                                                                      

Special Problems

Explain how you have addressed any special needs or problems raised by the Court Investigator, the Court, or other interested persons.

N/A

FINANCIAL NEEDS
Estimated Monthly Income
Social Security $                Estimated Income from other Sources$                
Pension (Type          )$                
Dividends
$                
Veterans Benefits$                
Rentals
$                
Supplemental Security Income$ 889.40    
Other
$                
Estimated Interest from Investment$                TOTAL Estimated Monthly Income$ 889.40    

Estimated Monthly Expenses

TAXES
Currently Paid?Next Due DateEstimated monthly amount
Incomesmall form box check Yes    small form box No N/A                     
$                      
Real Estatesmall form box check Yes    small form box No N/A                     
$                    0 

INSURANCE
CompanyPremium PaidCoverage AmountEstimated monthly amount
  Homeowners                           small form box Yes    small form box No                          
$                  
  Renters                           small form box Yes    small form box No                          
$                  
  Automobile                           small form box Yes    small form box No                          
$                  
  Workers Comp                           small form box Yes    small form box No                          
$                  
  Health                           small form box Yes    small form box No                          
$                  
  Life                           small form box Yes    small form box No                          
$                  
  Other                           small form box Yes    small form box No                          
$                  
LIVING EXPENSES
  Rent or Mortgage $                   Telephone $                
  Nursing Home or     Laundry and Cleaning $                
    Board and Care Home $                   Clothing $   50.00    
  Live-In Attendants $                   Entertainment and  
  Other Care Providers $  733.00           Recreation $   70.00    
  Medical and Dental Supplies $                   Transportation $   20.00    
  Food $                   Other $   16.40    
  Utilities $                   TOTAL Estimated Monthly Expenses $   156.40  

Describe any planned changes in investments to be made in the next year and the reason for any changes.

N/A

Identify any major asset that may be sold in the coming year and explain the reason for such sale.
 N/A                                                                                                                                                                

Identify the contents of any safety deposit box.
 N/A                                                                                                                                                                

Are there any valuable assets in the Conservatee’s residence that need to be protected? If so, describe them and specify what steps have been taken to protect these items from loss or theft.
 None                                                                                                                                                               

Date:                                                                    Date:                                                                   
  Attorney  Conservator

Form P74 GENERAL PLAN FOR PERSONAL AND FINANCIAL NEEDS OF CONSERVATEE
CONFIDENTIAL
2


Top