Fill and Sign the Limited Conservatorships the Superior Court of California County of Form

Conservatorship Questionnaire Conservator of the Person Conservator of the Estate Both Date: Name: Date Letters of Conservatorship were issued (if applicable): Limited: Yes No County for filing: Conservator Proposed conservator(s):Name: Home address: Work address: Telephone: (Home) (Work) E-Mail address: Date of birth: Social Security Number: Drivers license number: Expiration date: Relationship of proposed conservator of person, of person and estate, or of estate: What are your qualifications to act as conservator? Does proposed conservatee consent to conservatorship? Yes No Have you ever filed a bankruptcy petition for relief under Chapter 7 or Chapter 11 of the Federal Bankruptcy Act? Yes No Have you ever been convicted of a felony or any other crime involving bodily injury, elder abuse, theft, fraud, or embezzlement? Yes No For each offense, give the date of conviction and the offense charged: Have you had a restraining order or protective order filed against you in the last 10 years? Yes No Are you required to register as a sex offender? Yes No Have you been removed or asked to resign as a conservator, guardian, executor, or fiduciary in any other case?
Yes no name of all person(s) who are living in the home at the time you are appointed conservator. If any person is deceased during appointment, specify the name and date(s) of death. .......................................................................................................................................................................... For whom do you plan to live during the conservatorship? Name of any person(s), including legal representatives, executor(s), or trustee(s), known to you that will be permitted to reside in the home during the conservatorship. How will you protect their access to the home during the conservatorship? Will you have a housekeeper? .......................................................................................................................................................................................................................................... Will you be able to control the mail that arrives in the home? Will you have a telephone? if you can answer no to the above questions, choose “none." .......................................................................................................................................................................................................................................... .......................................................................................................................................................................................................................................... Name of person(s) (or organization) you intend to appoint as legal custodian(s) of person during conservatorship. If the person(s) appointed are not your biological or adoptive children, state whether they are related to you. If they are related, state whether they are the children of your spouse or if you have adopted them. If they aren't, state whether they are related to another person or if you are a stepparent or were stepparent during the date you were married or that person's date of death. (a stepparent would therefore be a parent to one's biological or adoptive children. A person appointed as legal custodian of a person would therefore be the natural or adoptive mother of those children.) if this person is a legal guardian or appointee, state whether he or she has any medical, mental or physical conditions that will prevent his or her ability to operate the home during the conservatorship. If this person is the father or mother of the person, state whether this person is involved in caring for that person or whether the person is on the age of majority. If this person is the next of kin of the person, state whether he or she is involved in caring for that person, whether the person is on the age of majority. (a next of kin would thus be a parent of one's biological or adoptive children.) if this person is not the next of kin of the person, state whether he or she is the next of kin of someone who might be appointed as the conservators for this person. (a next of kin would thus be the person's stepmother or step