I-H
SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION IN RE: __________________________________ An Adult Intervention Proceeding No.________________
PETITION OF CONSERVATOR FOR INSTRUCTIONS REGARDING STATEMENT OF CLAIM 1. A statement of claim was filed on__________________________________________ by ______________________________who seeks payment of_____________________ for the following described consideration:______________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 2. Conservator seeks instructions of the court regarding said claim:_________________ ________________________________________________________________________ ________________________________________________________________________ 3. The reasons such instructions are sought are:_________________________________ ________________________________________________________________________ ________________________________________________________________________ ______________________________ Attorney for Conservator ___________________________ Conservator
Form PD-1877A/Sep. 89
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 above captioned case and persons granted permission to SCR-PD 303 and persons who requested notice pursuant to SCR-PD 304. __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ _________________________________ _________________________________ _________________________________ _________________________________ __________________________________ __________________________________
__________________________________________ Signature
Form PD-1877B/Sep. 89