Free Conservatorship Plan - District of Columbia

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SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION IN RE:____________________________ An Adult CONSERVATORSHIP PLAN I,____________________________________________, appointed conservator in the above-captioned proceeding on __________________________, hereby submit the following conservatorship plan and attached inventory. THE FOLLOWING SERVICES ARE NECESSARY TO MANAGE THE FINANICAL RESOURCES DESIGNATED BY THE ORDER OF THE COURT: (Collecting assets; depositing and investing same; continuing or participating in the operations of businesses or other enterprises, etc). Intervention Proceeding No._______________

THE MEANS BY WHICH THESE SERVICES WILL BE PROVIDED ARE: (Employment of persons such as investment advisors to advise or assist with conservator's duties.)

THE MANNER IN WHICH THE INCAPACITATED INDIVIDUAL, GUARDIAN, CONSERVATOR, OR ANY OTHER INDIVIDUAL WHO HAS BEEN APPOINTED TO SERVE IN THAT CAPACITY WILL EXERCISE AND SHARE THEIR DECISION-MAKING AUTHORITY IS: (Report agreements regarding how decisionmaking authority will be shared.)

2 THE POLICIES AND PROCEDURES GOVERNING THE EXPENDITURE OF FUNDS ARE: (Report agreements reached regarding expenditures of funds.)

OTHER ITEMS THAT WILL ASSIST IN THE MANAGEMENT OF THE DESIGNATED FINANCIAL RESOURCES AND IN FULFILLING THE NEEDS OF THE INCAPACITATED INDIVIDUAL, THE TERMS OF THE COURT'S ORDER. AND THE DUTIES OF THE CONSERVATOR ARE: (Report the need, if any, for the Court to assign to conservator any duties or powers which the disabled person lacks the capacity to perform.)

Attach a complete inventory of financial resources designated by the order of the Court. A COPY OF THIS INDIVIDUAL CONSERVATORSHIP PLAN AND INVENTORY HAS BEEN SENT TO (insert names): The incapacitated individual:________________________________________________ Each party and their attorney of record: [anyone given party status by Court order pursuant to SCR-PD 303 (c) (f)] ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________

The individual most closely related to the subject by blood or marriage unless that individual's name or whereabouts is unknown and cannot be reasonably ascertained: ________________________________________________________________________ The individual or facility, if any, having custody of the subject: ________________________________________________________________________ The individual, if any, proposed for appointment by will as a guardian: ________________________________________________________________________ The individual, if any, appointed or proposed for appointment as guardian ad litem: ________________________________________________________________________ The duly appointed guardian, if any: ________________________________________________________________________

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If no persons listed above exist, notice should be sent to the previously appointed visitor: ________________________________________________________________________ Persons who have filed an effective request for notice pursuant to SCR-PD 304: ________________________________________________________________________ The Veterans Administration, if veterans benefits are being received: ________________________________________________________________________ I, the undersigned_______________________________________________do solemnly swear or affirm that the foregoing report is, to the best of my knowledge and belief, complete and accurate. Sworn to and subscribed before me this____day of____________________,20______. District of Columbia, S.S. Or State of____________________________, Country of____________________________

________________________________________________________________________ Notary Public Deputy/Register of Wills Deputy Clerk Certificate of Service I hereby certify that on the______day of ____________________, 20______, a copy of the foregoing______________________________________________________ was served by first class mail, postage prepaid, upon the following parties to the abovecaptioned case and persons granted permission to participate pursuant to SCR-PD 303 and person who requested notice pursuant to SCR-PD 304. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________

________________________________________________________________________ Signature