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TE L EP H O N E: S UPERIO R C OUR T O F C A L I FOR N I A , COU NTY OF ST R EET A DD RE S S: M A IL I N G A DD RE S S: CI T Y AN D ZI P COD E : BRA NCH N A M E :G UARDIANSHIP C O NSERVAT O RSHIP O F ( N a me ): a . b . N e w accou n t o p en e d o n (date): A ccou n t n u mber: E x ist i n g acc o unt cha n ge d o n (date): Ac cou n t n u mber : Be f ore cha n ge : A f t e r c h an g e: N a me on accou n t b e f o r e chan g e ( s t a t e e a ch n a me ) : Op e n i n g bala n ce o f n e w a cco u n t o r b a l a nce o f e x ist i n g a cco u n t immediatel y a f t e r c h an g e: $ S a f e -de p osi t b o x st a t u s ( c h eck o n e . Identif y a dditio n a l s a f e - d ep o s i t box e s on Attac h m ent 5): a . Ne w bo x rente d o n (date) : re fl e ctin g th e g uardianship or c o ns e rv atorship. I d eclare un d e r p en a l t y o f p er j ur y u nd e r the la w s o f the St a te o f Ca l i f ornia t h a t th e f ore g oing is true a n d correct. Date: ` ( T Y PE OR P RI NT N A M E OF AUT H O R I Z ED O F F I CE R ) ( SI G NAT U R E O F AUT H ORI Z ED O F F I C E R) ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– – – ––––– – – ––––– ––––– ––––– ––––– ––––– – – ––––– ––––– – ––––– ––––– ––––– ––––– ––––– – – ––––– – ––––– – – – ––––– ––––– ––––– ––––– ––––– –––––DE CL A R A N T (Na me ) : INSTI T U T I ON (Na me ) : A DD R E SS: TIT L E: F O R C OURT USE O N L Y GC- 051 F AX (Optio n al): M IN O R C ON SERVATEE NO FI L I N G FEE NO T IC E O F O PE NING O R CH A N G I N G A GU A R D I A NS H IP OR C O N SE R V A T O R S H IP A C C O UN T O R S A F E-D E P O S I T B O X C ASE NUM BE R : N OT E T O FIN A NCI A L IN ST IT UT ION : W hen a g u ardian or co n ser v ator o f th e e state o f a p erson o p en s o r ch a ng e s t h e name o n a n acc o unt o r a sa f e-de p osit b o x in a “ f in a ncia l inst i tution” ( a b an k , a tr u st, a sa vi n g s an d loa n a ssoc i ation, a sa v in g s b an k , a n ind u strial ba n k, o r a cre d it u nion) , th e instit u t ion must fi le a st a t em en t w it h th e court h a v in g jur i s d i ctio n o v er th e p r o ce e d i n g an d id e n t i fi ed i n the Letters o f Guard i ansh i p o r Letters o f Co n servators h i p . T h e st a t em ent mus t contain t h e i n f o r m a t ion s p eci f ie d b e l o w c o ncernin g e ach ne w o r e x i s ting accou n t or sa f e-d e pos it b o x i n th e instit u t ion . T h e statem e nt m u s t b e sig n e d b y a n a uthori z e d o ffi cer o f th e inst i tut i on. 1 . 2 . I am a n o ff ice r o f the fi n ancial i nstit u t io n ide n ti fi e d i n thi s st a t em ent, a n d I am a u t h or i z e d t o s i g n this stateme n t on it s b e hal f . T h e guar d i a n or c o nser v a t o r p r e s ente d L e t t e r s o f G ua rd i a n ship o r L ett er s o f Conservatorshi p i d enti f y in g th e g uardia n o r co n s er v ato r o f th e e stat e o f th e w ar d o r conser v ate e n ame d a b o v e . 3 . a . b . F i n a ncial instit u t io n (na m e) : Branc h ( n a m e): (street ad d r e ss): (c i ty an d z ip co d e): (telep h on e ): 4 . A c cou n t statu s (ch e ck on e ; i d entify a d ditio n a l n e w or exist i n g acc o unts on Attac h m ent 4): ( 1 ) ( 2 ) ( 1 ) r e f lecting the g u ardians h ip o r c o nser v a t o rsh i p . to re fl e ct the g u ardiansh ip o r c o nser v a t o rship. ( 2 ) ( 3 ) 5 . c . b . c . E x istin g b o x r e nta l c h an g ed to r e f lect the gu a rd i a ns h i p or co n ser v ators h ip o n ( d ate): Ne w sa f e-de p osit b o x n umb e r or curre n t n u m b er a f t e r ch a ng e : d . T h i s inst i tution h a s has n o t b e en gi v e n a cces s to t h e sa f e-de p osit b o x i d e nt if ied ab o v e. e . (If yo u c h eck e d "has," co m plete i te m 5 e .) T he co n t e nts o f th e s a f e -dep o sit bo x ide n ti fi e d ab o v e are as f ol l o w s ( l ist th e c o ntent s i n g en e r a l ter m s, s u c h a s "currency, c o i n s, jewelry, t a bleware , insuranc e p ol i cies or cert i f i c ates , st o ck certif i c a t e s , b onds, d e eds, an d wi l ls"): 6 . N a me o f e ach p e rson w ho o p en e d o r w h o s e nam e w as a d de d to a b o v e - id e nt ifi e d acc o unt o r s a f e -de p osit b o x (state each na m e): P a g e 1 o f 1 For m A dop t ed fo r Manda t or y Use J u di c ia l Co u nci l o f C ali f ornia G C-051 [ R e v . Jul y 1 , 2005] NO T IC E O F O PE NING O R CH A N G I N G A GU A R D I A N S H IP OR C O N SE R V A T O R S H IP A C C O UN T O R S A F E-D E P O S I T B O X ( P r o b a t e—G u a r dia n shi p s an d C o ns e r v a t o r s hips ) P r o bat e Co d e , § 2 89 2elec troni c form ã 2005 WWW.LawCA.co m L a w P u b l i s h e r s