Free GC-312 CONFIDENTIAL SUPPLEMENTAL INFORMATION (Probate Conservatorship) - California

COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . .(DO .NOT .ATTACH TO PETITION) CONFIDENTIAL . . . . . . . . . . . . . . . . . . . ......... .. ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): FOR COURT USE ONLY : Index No. :
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GC-312

Calendar No.

Plaintiff(s) -against-

: : : :

JUDICIAL SUBPOENA

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

CONSERVATORSHIP OF (Name):

Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PROPOSED CONSERVATEE .............
CONFIDENTIAL SUPPLEMENTAL INFORMATION
CASE NUMBER:

Conservatorship of

(Probate Conservatorship) Person Estate Limited Conservatorship
HEARING DATE:

THE PEOPLE OF THE STATE OF NEW YORK
1. a. Proposed conservatee (name): b. Date of birth: TO c. Social security No.: 2.

DEPT.:

TIME:

WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the

UNABLE TO PROVIDE FOR PERSONAL NEEDS* The following facts support petitioner's allegation that the proposed conservatee is GREETINGS: unable to provide properly for his or her needs for physical health, food, clothing, and shelter (specify in detail, enlarging upon the reasons stated in the petition; provide specific examples from the proposed conservatee's daily life showing significant behavior patterns): Specified in Attachment 2.

Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20

(Attorney must sign above and type name below)

Attorney(s) for

Office and P.O. Address

* If this item is not applicable, complete item 8.
Form Adopted for Mandatory Use Judicial Council of California GC-312 [Rev. January 1, 2001]

CONFIDENTIAL SUPPLEMENTAL INFORMATION
(Probate Conservatorship)

Telephone No.: Facsimile No.: E-Mail Address: (Continued on reverse) Mobile Tel. No.:

Page one of four Probate Code, § 1821

American LegalNet, Inc. www.USCourtForms.com

CONFIDENTIAL
CONSERVATORSHIP OF (Name): PROPOSED CONSERVATEE
CASE NUMBER:

3.

UNABLE TO MANAGE FINANCIAL RESOURCES* The following facts support petitioner's allegation that the proposed conservatee is substantially unable to manage his or her financial resources or to resist fraud or undue influence (specify in detail, enlarging upon the reasons stated in the petition; provide specific examples from the proposed conservatee's daily life showing significant behavior patterns): Specified in Attachment 3.

4. RESIDENCE ("Residence" means the place usually described as "home"; for example, owned real property or long-term rental.) a. The proposed conservatee is located at (street address, city, state):

b. The proposed conservatee's residence is*

the address in item 4a

other (street address, city, state):

c. Ability to live in residence* The proposed conservatee is (1) living in his or her residence and (a) will continue to live there unless circumstances change. (b) will need to be moved after a conservator is appointed (specify supporting facts below in item 4c(3)). (c) other (specify and give supporting facts below in item 4c(3)). * If this item is not applicable, complete item 8.
(Continued on page three)
GC-312 [Rev. January 1, 2001]

CONFIDENTIAL SUPPLEMENTAL INFORMATION
(Probate Conservatorship)

Page two of four

CONFIDENTIAL
CONSERVATORSHIP OF (Name): PROPOSED CONSERVATEE
CASE NUMBER:

4. c. (continued) (2) not living in his or her residence and (a) will return by (date): (specify supporting facts below in item 4c(3)). (b) will not return to live there (specify supporting facts below in item 4c(3)). (c) other (specify and give supporting facts below in item 4c(3)). (3) Supporting facts (specify if required): Specified in Attachment 4c.

5. ALTERNATIVES TO CONSERVATORSHIP* Petitioner has considered the following alternatives to conservatorship and found them to be unsuitable or unavailable to the proposed conservatee (specify the alternatives considered and the reason or reasons each is unsuitable or unavailable): Reasons specified in Attachment 5. a. Voluntary acceptance of informal or formal assistance (give reason this is unsuitable or unavailable):

b. Special or limited power of attorney (give reason this is unsuitable or unavailable):

c. General power of attorney (give reason this is unsuitable or unavailable):

d. Durable power of attorney for

health care

estate management

(give reason this is unsuitable or unavailable):

e. Trust (give reason this is unsuitable or unavailable):

f.

Other alternatives considered (specify and give reason each is unsuitable or unavailable):

6. SERVICES PROVIDED* (complete a or b, or both a and b) a. During the year before this petition was filed, were provided were not provided (1) health services Explained in Attachment 6a(1).

to the proposed conservatee (explain):

were provided (2) social services Explained in Attachment 6a(2).

were not provided

to the proposed conservatee (explain):

* If this item is not applicable, complete item 8.
(Continued on page four)
GC-312 [Rev. January 1, 2001]

CONFIDENTIAL SUPPLEMENTAL INFORMATION
(Probate Conservatorship)

Page three of four

CONFIDENTIAL
CONSERVATORSHIP OF (Name): PROPOSED CONSERVATEE
CASE NUMBER:

6. a. (continued) (3) estate management assistance conservatee (explain): Explained in Attachment 6a(3).

was provided

was not provided

to the proposed

b.

Petitioner has no knowledge of what health services estate management social services assistance was provided to the proposed conservatee during the year before this petition was filed. Petitioner has no reasonable means of determining what services were provided.

7. SUPPORTING FACTS (AFFIDAVITS) The information provided above is stated in an affidavit (declaration) by another person attached as Attachment 1a. a. Item 1: on petitioner's own knowledge in an affidavit (declaration) by another person attached as Attachment 2a. on petitioner's own knowledge b. Item 2: in an affidavit (declaration) by another person attached as Attachment 3a. on petitioner's own knowledge c. Item 3: in an affidavit (declaration) by another person attached as Attachment 4a. on petitioner's own knowledge d. Item 4: in an affidavit (declaration) by another person attached as Attachment 5a. on petitioner's own knowledge e. Item 5: in an affidavit (declaration) by another person attached as Attachment 6a. on petitioner's own knowledge f. Item 6: 8. ITEMS NOT APPLICABLE The following items on this form were not applicable to the proposed conservatee: 2 3 4b 4c 5 6 (specify reasons each item is not applicable): Reasons specified in Attachment 8.

9. Number of pages attached: _____

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)

(SIGNATURE OF PETITIONER)

GC-312 [Rev. January 1, 2001]

CONFIDENTIAL SUPPLEMENTAL INFORMATION
(Probate Conservatorship)

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