GC-310 Petition for Appointment of Probate Conservator

GC-310

 

1. Petitioner (name): John Doe & Jane Doe                           requests that

a.(Name): John Doe & Jane Doe                                                    (Telephone): 415-123-4567
(Address):
1234 ABC Street, San Francisco, CA 94102

be appointed successor conservator limited conservator
of the PERSON of the (proposed) conservatee and Letters issue upon qualification.
b. (Name):                                                                                  (Telephone):

(Address):


c. (1) bond not be required because the proposed successor        conservator is a corporate fiduciary
             or an exempt government agency.         for the reasons stated in Attachment 1c.
    (2) bond be fixed at: $                 to be furnished by an authorized surety company or as otherwise
             provided by law. (Specify reasons in Attachment 1c if the amount is different from the minimum
             required by Probate Code section 2320.)
    (3) $              in deposits in a blocked account be allowed. Receipts will be filed.
             (Specify institution and location):

d. orders authorizing independent exercise of powers under Probate Code section 2590 be granted.
        Granting the proposed successor         conservator of the estate powers to be exercised independently under
        Probate Code section 2590 would be to the advantage and benefit and in the best interest of the conservatorship
        estate. (Specify orders, powers, and reasons in Attachment 1d.)
e. orders relating to the capacity of the (proposed) conservatee under Probate Code section 1873 or 1901 be
        granted. (Specify orders, facts, and reasons in Attachment 1e.)
f. orders relating to the powers and duties of the proposed successor         conservator of the person under
        Probate Code sections 2351–2358 be granted. (Specify orders, facts, and reasons in Attachment 1f.)
g. the (prosed) conservatee be adjudged to lack the capacity to give informed consent for medical treatmentor
        healing by prayer and that the proposed successor         conservator of the person be granted the powers specified
        in Probate Code section 2355. (Complete item 9 on page6.)

Do NOT use this form for a temporary conservatorship.

Page 1 of 8

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1. h. (for limited conservatorship only) orders relating to the powers and duties of the proposed limited
             successor*
            conservator of the person under Probate Code section 2351.5 be granted. (Specify orders, powers,
            and duties in Attachment 1h and complete item 1j.)
    i. (for limited conservatorship only) orders relating to the powers and duties of the proposed limited
             successor*
            conservator of the estate under Probate Code section 1830(b) be granted. (Specify orders, powers,
            and duties in Attachment 1i and complete item 1j.)
    j. (for limited conservatorship only) orders limiting the civil and legal rights of the (proposed) limited conservatee
            be granted. (Specify limitations in Attachment 1j.)
    k. orders related to dementia placement or treatment as specified in the Attachment Requesting Special Orders
            Regarding Dementia (form GC-313) under Probate Code section 2356.5 be granted. A Capacity Declaration—
            Conservatorship (form GC-335) and Dementia Attachment to Capacity Declaration—Conservatorship (form
            GC-335A), executed by a licensed physician or by a licensed psychologist acting within the scope of his or her
            licensure with at least two years experience diagnosing dementia, are filed herewith.
             will be filed before the hearing.
             (appointment of successor conservator only) will not be filed because an order relating to dementia
                placement or treatment was filed on (date):               . That order has neither expired by its terms nor been
                revoked.
    I. other orders be granted. (Specify in Attachment 1l.)
2. (Proposed) conservatee is (name): Terry Morgan Doe                                      (Telephone): 415-123-4567
    (Present address):
    1234 ABC Street, San Francisco, CA 94102

3. a. Jurisdictional facts (initial appointment only) The proposed conservatee has no conservator in California and is a
       (1) resident of California and
            (a) a resident of this county.
            (b) not a resident of this county, but commencement of the conservatorship in this county is in the best
                     interests of the proposed conservatee for the reasons specified in Attachment 3a.
       (2) nonresident of California but
            (a) is temporarily living in this county, or
            (b) has property in this county, or
            (c) commencement of the conservatorship in this county is in the best interest of the proposed conservatee
                     for the reasons specified in Attachment 3a.
b. Petitioner (answer items (1) and (2) and check all other items that apply)
    (1) is is not a creditor or an agent of a creditor of the (proposed) conservatee.
    (2) is is not a debtor or an agent of a debtor of the (proposed) conservatee.
    (3) is the proposed successor         conservator.
    (4) is the (proposed) conservatee. (If this item is not checked, you must also complete item 3f.)
    (5) is the spouse of the (proposed) conservatee. (You must also complete item 6.)
    (6) is the domestic partner or former domestic partner of the (proposed) conservatee. (You must also complete item 7.)
    (7) is a relative of the (proposed) conservatee as (specify relationship): Father and Mother
    (8) is an interested person or friend of the (proposed) conservatee.
    (9) is a state or local public entity, officer, or employee.
   (10) is the guardian of the proposed conservatee.
   (11) is a bank is other entity authorized to conduct the business of a trust company.
   (12) is a professional fiduciary within the meaning of Business and Professions Code section 6501(f) who is
            licensed by the Professional Fiduciaries Bureau of the Department of Consumer Affairs. Petitioner's license
            number is provided in item 1 on page 1 of the attached Professional Fiduciary Attachment. (Use form
            GC-210(A-PF)/GC-310(A-PF) for this attachment. You must also complete item 2 on page 2 of that form and
            item 3d below.)


* See item 5b on page 4.

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3. c. Proposed successor         conservator is (check all that apply)
    (1) a nominee. (Affix nomination as Attachment 3c(1).)
    (2) the spouse of the (proposed) conservatee. (You must also complete item 6.)
    (3) the domestic partner or former domestic partner of the (proposed) conservatee. (You must also complete item 7.)
    (4) a relative of the (proposed) conservatee as (specify relationship): Father and Mother
    (5) a bank. other entity authorized to conduct the business of a trust company.
    (6) a nonprofit charitable corporation that meets the requirements of Probate Code section 2104.
    (7) a professional fiduciary, as defined in Business and Professions Code section 6501(f). His or her statement
            concerning licensure or exemption is provided in item 1 on page 1 of the attached Professional Fiduciary
            Attachment. (Use form GC-210(A-PF)/GC-310(A-PF) for this attachment.)
    (8) other (specify):


d. Engagement and prior relationship with petitioning professional fiduciary (complete this item if petitioner is
        licensed by the Professional Fiduciaries Bureau.)
    (1) Statements of who engaged petitioner, or how petitioner was engaged to file this petition, and a description of
            any prior relationship petitioner had with the (proposed) conservatee or his or her family or friends, are
            provided in item 2 on page 2 of the attached Professional Fiduciary Attachment. (Use form GC-210(A-PF)/
            GC-310(A-PF) for this attachment.)
    (2) A petition for appointment of a temporary conservator is filed with this petition. That petition contains
            statements of who engaged petitioner, how petitioner was engaged to file this petition, and a description of any
            prior relationship petitioner had with the (proposed) conservatee or his or her family and friends.
e. Character and estimated value of the property of the estate (complete items (1) or (2) and (3), (4), and (5)):
    (1) (For appointment of successor         conservator only, if complete Inventory and Appraisal filed by             predecessor):
            Personal property: $        , per Inventory and Appraisal filed in this proceeding on
            (specify dates of filing of all inventories and appraisals):


    (2) Estimated value of personal property:                 $ 500.00
    (3) Annual gross income from
         (a) real property:                                                  $
         (b) personal property:                                           $
         (c) pensions:                                                        $
         (d) wages:                                                           $
         (e) public assistance benefits:                                $ 8796
         (f) other:                                                             $
    (4) Total of (1) or (2) and (3):                                    $ 9296
    (5) Real property:                                                      $
         (a) per Inventory and Appraisal identified in item (1).
         (b) estimated value.
f. Due diligence (complete this item if the (proposed) conservatee is not a petitioner):
   (1) Efforts to find the (proposed) conservatee's relatives or reasons why it is not feasible to contact any of them are         described on Attachment 3f(1).
   (2) Statements of the (proposed) conservatee's preferences concerning the appointment of any (successor)
        conservator and the appointment of the proposed (successor) conservator or reasons why it is not feasible to
        ascertain those preferences are contained on Attachment 3f(2).

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3. g. So far as known to Petitioner, a conservatorship or equivalent proceeding concerning the proposed conservatee
         has not has been filed in another jurisdiction concerning the proposed conservatee, including a court of an
                                 Indian tribe with jurisdiction (see Prob. Code, § 2031(b)).
        (If you answered "has," identify the jurisdiction and state the date the case was filed):

4. (Proposed) conservatee
    a. is is not a patient in or on leave of absence from a state institution under the jurisdiction of the California
        Department of State Hospitals or the California Department of Developmental Services (specify state institution):


    b. is receiving or entitled to receive is neither receiving nor entitled to receive
        benefits from the U.S. Department of Veterans Affairs (estimate amount of monthly benefit payable):
    c. is is not , so far as is known to petitioner, a member of a federally recognized Indian tribe.
        (If you answered "is," complete items (1)–(4)):
        (1) Name of tribe:
        (2) Location of tribe (if the tribe is located in more than one state, the state that is the tribe's principal location):

        (3) The proposed conservatee does does not reside on tribal land.*
        (4) So far as known to petitioner, the proposed conservatee owns does not own property on tribal land.
5. a. Proposed conservatee (initial appointment of conservator only)
       (1) is an adult.
       (2) will be an adult on the effective date of the order (date):  1/1/2016
       (3) is a married minor.
       (4) is a minor whose marriage has been dissolved.
    b. Vacancy in office of conservator (appointment of successor         conservator only. A petition for appointment of a limited
            conservator after the death of a predecessor is a petition for initial appointment. (Prob. Code, 1860.5(a)(1).)
            There is a vacancy in the office of conservator of the person estate for the reasons
            specified in Attachment 5b. specified below.



















* “Tribal land” is land that is, with respect to a specific Indian tribe and the members of that tribe, “Indian country,” as defined in 18 U.S.C. § 1151.

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5. c. (Proposed) conservatee requires a conservator and is
         (1) unable to properly provide for his or her personal needs for physical health, food, clothing, or shelter.
                  Supporting facts are specified in Attachment 5c(1) as follows:






















     (2) substantially unable to manage his or her financial resources or to resist fraud or undue influence.
              Supporting facts are specified in Attachment 5c(2) as follows:

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5. d. (Proposed) conservatee voluntarily requests the appointment of a successor conervator.
           (Specify facts showing good cause in Attachment 5(d).)
    e. Confidential Supplemental Information (form GC-312) is filed with this petition. (Initial appointment of
           conservator only. All petitioners must file this form except banks and other entities authorized to do business
           as a trust company.)
    f. (Proposed) conservatee is is not developmentally disabled as defined in Probate Code section 1420.
       Petitioner is aware of the requirements of Probate Code section 1827.5. (Specify the nature and degree of the
       alleged disability in Attachment 5f).
6. Petitioner or proposed successor         conservator is the spouse of the (proposed) conservatee.
       (If this statement is true, you must answer a or b.)
    a. The (proposed) conservatee's spouse is not a party to any action or proceeding against the (proposed)
           conservatee for legal separation, dissolution of marriage, annulment, or adjudication of nullity of their marriage.
    b. Although the (proposed) conservatee's spouse is a party to an action or proceeding against the (proposed)
           conservatee for legal separation, dissolution, annulment, or adjudication of nullity of their marriage, or has
           obtained a judgment in one of these proceedings, it is in the best interest of the (proposed) conservatee that:
        (1) a successor         conservator be appointed.
        (2) the spouse be appointed as the successor         conservator.
        (If you checked item 6b(1) or (2) or both, specify the facts and reasons in Attachment 6b.)
7. Petitioner or proposed successor         conservator is the domestic partner or former domestic partner of the
        (proposed) conservatee. (If this statement is true, you must answer a or b.)
    a. The domestic partner of the (proposed) conservatee has not terminated and does not intend to terminate the
            domestic partnership.
    b. Although the domestic partner or former domestic partner of the (proposed) conservatee intends to terminate
            or has terminated the domestic partnership, it is in the best interest of the (proposed) conservatee that
        (1) a successor         conservator be appointed.
        (2) the domestic partner or former domestic partner be appointed as the successor         conservator.
        (If you checked item 7b(1) or (2) or both, specify the facts and reasons in Attachment 7b.)
8. (Proposed) conservatee (check all that apply)
    a. will attend the hearing AND is the petitioner is not the petitioner AND has has not nominated the             proposed successor          conservator.
    b. (initial appointment of conservator only) is able but unwilling to attend the hearing AND does does not wish to
          contest the establishment of a conservatorship, does does not object to the proposed conservator, AND
          does does not prefer that another person act as conservator.
    c. (initial appointment of conservator only): is unable to attend the hearing because of medical inability. A Capacity
           Declaration—Conservatorship (form GC-335), executed by a licensed medical
           practitioner or an accredited religious practitioner is filed with this petition.    will be filed before the hearing.
    d. (initial appointment of conservator only) is not the petitioner, is out of state, and will not attend the hearing.
    e. (appointment of successor conservator only) will not attend the hearing.
9. Medical treatment of (proposed) conservatee
    a. There is no form of medical treatment for which the (proposed) conservatee has the capacity to give an informed         consent.
    b. A Capacity Declaration—Conservatorship (form GC-335) executed by a licensed physician or by a licensed psychologist acting
        within the scope of his or her licensure, stating that the (proposed) conservatee lacks the capacity to give informed consent
        for any form of medical treatment and giving reasons and the factual basis for this conclusion,
         is filed with this petition. will be filed before the hearing will not be filed for the reason stated in c.
    c. (appointment of successor conservator only) The conservatee's incapacity to consent to any form of medical            treatment was determined by order filed in this matter on (date):
           That order has neither expired by its terms nor been revoked.
    d. (Proposed) conservatee is is not an adherent of a religion that relies on prayer alone for healing, as defined in         Probate Code section 2355(b).

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10. Temporary conservatorship
            Filed with this petition is a Petition for Appointment of Temporary Conservator (form GC-111).
11. (Proposed) conservatee's relatives
      The names, residence addresses, and relationships of the spouse or registered domestic partner and thesecond-degree
      relatives of the (proposed) conservatee (his or her parents, grandparents, children, grandchildren, and brothers and sisters),
      so far as known to petitioner, are
      a. listed below.
      b. not known, or no longer living, so the (proposed) conservatee's deemed relatives under Probate Code section 1821(b)
      (1)–(4) are listed below.

	Name and relationship to conservatee	Residence address
(1)	John Doe, Father	1234 ABC Street San Francisco, CA 94102
(2)	Jane Doe, Mother	1234 ABC Street San Francisco, CA 94102
(3)
(4)	All Proposed Conservatee's grandparents are deceased and proposed conservatee has no siblings
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)

                       Continued on Attachment 11.

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12. Confidential conservator screening form
          Submitted with this petition is a Confidential Conservator Screening Form (form GC-314) completed and signed by the
          proposed successor         conservator. (Required for all proposed conservators except banks and trust companies.)
13. Court investigator
          Filed with this petition is a proposed Order Appointing Court Investigator (form GC-330).

14. Number of pages attached:

Date:

(TYPE OR PRINT NAME OF ATTORNEY FOR PETITIONER)

(SIGNATURE OF ATTORNEY FOR PETITIONER)

(All petitioners must also sign (Prob. Code, § 1020; Cal. Rules of Court, rule 7.103).)

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

Date: 1/30/2016

John Doe
(TYPE OR PRINT NAME OF PETITIONER)	(SIGNATURE OF PETITIONER)
Jane Doe
(TYPE OR PRINT NAME OF PETITIONER)	(SIGNATURE OF PETITIONER)

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ATTACHMENT lc TO PETITION: ALLEGATION REGARDING BOND

As the Conservatee possesses no estate and only receives public benefits, Petitioners respectfully request that bond be waived in this matter.

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ATTACHMENT lh TO PETITION: ORDERS RELATING TO POWERS AND DUTIES OF THE PROPOSED LIMITED CONSERVATOR OF THE PERSON UNDER PROBATE CODE SECTION 2351.5

Petitioners request the following powers over the Conservatee's person:

(1) To fix the residence or specific dwelling of the limited Conservatee.

(2) Access to the confidential records and papers of the limited Conservatee.

(3) To consent or withhold consent to the marriage of, or the entrance into a registered domestic partnership by, the limited Conservatee.

(4) The right of the limited Conservatee to contract.

(5) The power of the limited Conservatee to give or withhold medical consent.

(6) The limited Conservatee's right to control his or her own social and sexual contacts and relationships.

(7) Decisions concerning the education of the limited Conservatee.

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ATTACHMENT lj TO PETITION: ORDERS LIMITING THE CIVIL AND LEGAL RIGHTS OF THE PROPOSED LIMITED CONSERVATEE:

Petitioners request that the court limit the civil and legal rights of the proposed

(1) The right of the proposed Conservatee to fix the residence or specific dwelling of the limited Conservatee.

(2) The right of the proposed Conservatee to access the confidential records and papers of the limited Conservatee.

(3) The right of the proposed Conservatee to consent or withhold consent to the marriage of or the entrance into a registered domestic partnership by the limited Conservatee.

(4) The right of the limited Conservatee to contract.

(5) The power of the limited Conservatee to give or withhold medical consent.

(6) The limited Conservatee's right to control his or her own social and sexual contacts and relationships.

(7) The right of the proposed Conservatee to make decisions concerning the education of the limited Conservatee.

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ATTACHMENT 3f(l) TO PETITION: PROPOSED CONSERVATEE'S RELATIVES

The identities and addresses of proposed Conservatee's relatives who are entitled to notice are all known and stated in Paragraph 11.

ATTACHMENT 3f(2) TO PETITION: ALLEGATIONS REGARDING PROPOSED CONSERVATEE'S PREFERENCES CONCERNING THE APPOINTMENT OF ANY CONSERVATOR AND OF THE PROPOSED CONSERVATOR

Conservatee was diagnosed with autism and mental retardation at three years old and is not able to make such statements regarding his preferences regarding the appointment of a conservator.

ATTACHMENT 5c(l) and 5c(2): FACTS IN SUPPORT

Proposed Conservatee is diagnosed with Autism. A detailed description of his condition is set forth in the attached Operating Instructions for Terry Doe, consisting of eight pages.

ATTACHMENT 5(f) TO PETITION: ALLEGATIONS REGARDING NATURE AND DEGREE OF CONSERVATEE'S DEVELOPMENTAL DISABILITY

Proposed conservatee is a 17 year old autistic man/woman. He was diagnosed with autism at a young age, and a detailed description of his condition is set forth in the attached Operating Instructions for Terry Doe.

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