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Fill and Sign the Medical Certificate Form 44147526

Fill and Sign the Medical Certificate Form 44147526

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GC-112(A-1) CASE NUMBER: TEMPORARY CONSERVATORSHIP OF (Name): CONSERVATEE DECLARATION IN SUPPORT OF EX PARTE APPLICATION FOR GOOD CAUSE EXCEPTION TO NOTICE OF HEARING ON PETITION FOR APPOINTMENT OF TEMPORARY CONSERVATOR * I (name): declare as follows: 1. (This box must be checked unless the declarant is an expert witness.) I have personal knowledge of the facts stated in this declaration and could and would testify competently to those facts. 2. I am an expert witness. My qualifications are stated below. 3. (Continue declaration here, number each paragraph consecutively on this page and on all continuation pages.) Date and signature are on the last page of this declaration. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME OF DECLARANT) (SIGNATURE OF DECLARANT) * Use Declaration Continuation Page (form GC-112(A-2)) for additional pages of the declaration. Page 1 of Form Approved for Optional Use Judicial Council of California GC-112(A-1) [New January 1, 2009] DECLARATION IN SUPPORT OF EX PARTE APPLICATION FOR GOOD CAUSE EXCEPTION TO NOTICE OF HEARING ON PETITION FOR APPOINTMENT OF TEMPORARY CONSERVATOR (Probate—Guardianships and Conservatorships) Probate Code, § 2250; Cal. Rules of Court, rule 7.1062 www.courtinfo.ca.gov

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