Fill and Sign the Annual Certification of Court Appointed Attorney Form

GC-011 Page 1 of 1 Probate Code, §§ 1456, 1470, 1471; Cal. Rules of Court, rule 7.1101 Form Adopted for Mandatory Use Judicial Council of California GC-011 [New January 1, 2009] SUPERIOR COURT OF CALIFORNIA, COUNTY OF ANNUAL CERTIFICATION OF COURT-APPOINTED ATTORNEY (Probate—Guardianships and Conservatorships) CONFIDENTIAL—FOR COURT USE ONLY (Do not file or lodge in case file) NOTICE TO ATTORNEYS APPOINTED BY THE COURT IN PROBATE CONS ERVATORSHIPS OR GUARDIANSHIPS Beginning in 2008, you must complete th ree hours of continuing education each ca lendar year that qualifies for Minimum Continuing Legal Education (MCLE) credit for California State Bar–certified specialists in estate planning, trust, and probate law. (See Cal. Rules of Court, rule 7.1101(f).) STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: CERTIFYING ATTORNEY State Bar No.: ANNUAL CERTIFICATION OF COURT -APPOINTED ATTORNEY 1. (Name): I certify as follows (check all boxes that apply): 2. My contact information is Firm or employer name: a. b. Address: c. Telephone number: d. Fax number: e. E-mail address: 1. 2. Beginning in 2009, you must certify to the court before the end of March of each ye ar that (1) you completed the required con tinuing education during the previous calendar year, and (2) your State Bar disciplinary history and professional liability insurance o r self-insurance coverage either hav e or have not changed since your qualification certification or last annual certification was filed. You must also describe any changes in your disciplinary history and insurance or se lf-insurance coverage. (See rule 7.1101(h)(4 ) and (5).) I certify that the foregoing is true and correct. Dated: (SIGNATURE) (TYPE OR PRINT NAME OF CERTIFYING ATTORNEY ) as stated in my qualificat ion certification or last annual certification. a. I have had no State Bar discipline imposed since the date of my qualification certific ation or my last annual certification. I have had State Bar discipline imposed since the date of my qua lification certificat ion or my last annu al certification. The circumstances are described in Attachment 1b. 3. a. My professional liability insurance coverage (rule 7.1101(b )(3)), adequacy of self-insurance (rule 7.1101(e)(2)), or self-insurance program coverage (rule 7. 1101(c)(2)) has not changed since the date of my qualification certification or my last annual certification. My professional liability insurance, a dequacy of self-insurance, or self-insurance program coverage has changed since the date of my qualification certification or my last contin uing education certification. My current circumstances are described in Attachment 2b. b. as follows: b. 4. hours of continuing education that qualifies for MCLE , I completed a total of (specify): During calendar year credit for State Bar-certified spec ialists in estate planning, trust, and probate law, as follows: Provider Subject Hours Total hours: