Free Final Account and Report of Conservator and Petition for Approval of Account and Report (PR-E-LP-028) - California

PR-E-LP-028

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ATTORNEY'S NAME OR PETITIONER NAME IN PRO PER ATTORNEY'S BAR NUMBER: STREET ADDRESS: CITY, STATE, ZIP CODE: TELEPHONE NUMBER: EMAIL: FAX:

IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF SACRAMENTO

No. In re: Conservatorship of the ( ) person and ( ) estate of:

Dept. 129

_____________________, Conservatee (state name)

FINAL ACCOUNT AND REPORT OF CONSERVATOR AND PETITION FOR APPROVAL OF ACCOUNT AND REPORT, ( ) AND FOR APPROVAL OF CONSERVATOR'S FEES ( ) AND ATTORNEY'S FEES ( ) AND FOR DISTRIBUTION OF ASSETS ON HAND ( ) OTHER (State):

Hearing Date: Time: Calendar No.:

Petitioner, ___________________, respectfully represents:
(Name)

1. Appointment. On __________, Petitioner was appointed as
(Date)

Conservator of the person/estate of ____________________. The Letters of
(Name)

Administration were issued on _________. At all times since the appointment, (Date) Petitioner has been acting as the Conservator.

OPTIONAL PR-E-LP-028 (1.1.07)

-1Final Account and Report of Conservator LOCAL RULE 15.100

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2. The conservatorship is no longer necessary because (check applicable box) ( ) the conservatee is deceased, having passed away on: __________; ( ) The assets of
(Date)

the estate have been exhausted and there are no longer any assets remaining which would require a conservatorship; ( ) The conservatorship has been terminated by the court; ( ) Other (state reason): 3. Period of Account. The account and report covers the period beginning __________, and ending ___________.
(Date) (Date)

4. Inventory and Appraisement. The Inventory and Appraisement was filed on: __________, showing the value of the estate to be: $ __________.
(Date)

Supplemental Inventory and Appraisements was filed on: __________, stating the value of assets to be: $ ___________. 5. Account Petitioner is chargeable and is entitled to credits, respectively, as set forth in attached "Exhibit A', summary of account, and supporting schedules. 5a. Financial Account Statements. Note: The conservator must attach an original account statement stating value for any asset held at close of this accounting period from the following type of financial institution: insurance company, broker or agent, investment company or bank, securities broker-dealer, investment advisor or financial planner, bank trust, savings and loan, industrial bank or credit union. Check the applicable box: ( ) Petitioner has attached the required financial institution statements on Exhibit "2". ( ) Petitioner has filed herewith a separate affidavit captioned "Confidential Financial Statement" with attached financial institution statements containing confidential information.

OPTIONAL PR-E-LP-028 (1.1.07)

-2Final Account and Report of Conservator LOCAL RULE 15.100

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6. Interest Bearing Accounts. If applicable, check the box: ( ) All the cash was invested and maintained in interest bearing accounts or in investments authorized by law or the governing instrument, except for an account of cash that was reasonably necessary for the orderly administration of the estate. 7. Sales, Purchases, Change in form of assets. During the period of this report; sales, purchases or change in form of assets ( ) did ( ) did not occur. If in the affirmative, describe the transactions.

8. Unusual Items in the Account. There ( ) were ( ) were not unusual items in the accounting requiring explanation. If in the affirmative, describe the transactions.

9. Income from Business or Trade. There ( ) was ( ) was not any income or loss from a trade or business. If in the affirmative, describe.

OPTIONAL PR-E-LP-028 (1.1.07)

-3Final Account and Report of Conservator LOCAL RULE 15.100

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 OPTIONAL PR-E-LP-028 (1.1.07) -4Final Account and Report of Conservator LOCAL RULE 15.100 Petitioner requests: ( ) Additional Bond: $ ______________ Current Bond: $ ___________ 11. Bond Report. Fair Market, Value of Assets (do not include real property) : $ ___________ Annual Income or Receipts from all sources: Total Bondable Estate: $ ___________ $ ___________ 10. Liabilities of the Estate. There ( ) are ( ) are not any outstanding debts (includes tax due, notes payable, court judgments) at the end of the accounting period. If in the affirmative, describe the debts, date of creditor claim, amount owed, terms:

Current Assets in Blocked Account: $ ___________ Total: $ ___________

( ) Reduction in Bond: $ ______________ ( ) No change in amount of bond. ( ) Additional assets be ordered blocked as follows (state amount, financial institution):

PR-E-LP-028

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 OPTIONAL PR-E-LP-028 (1.1.07) -5Final Account and Report of Conservator LOCAL RULE 15.100 14. State Hospital. The conservatee ( ) was ( ) was not a patient on leave of absence from a state hospital. 15. Testate/Intestate. If conservatee is deceased, check applicable box: ( ) conservatee died with a ( ) Will ( )Trust; ( ) conservatee died without a ( ) Will ( )Trust. 16. MediCal Benefits. If conservatee is deceased, check applicable box: conservatee ( ) did ( ) did not receive Medi-Cal Benefits. 13. Veteran's Administration. The conservatee ( ) was ( ) was not entitled to receive Veteran's Administration Benefits. 12. Family or Affiliate Relationship. There ( ) were ( ) were not any family or affiliate relationships between the fiduciary and any agent hired by the fiduciary during the accounting period. If in the affirmative, describe.

PR-E-LP-028

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 OPTIONAL PR-E-LP-028 (1.1.07) -6Final Account and Report of Conservator LOCAL RULE 15.100 List all persons entitled to notice of the hearing on the petition, state name, address, & relationship to decedent of all heirs at law, beneficiaries of a Will or trust, named executors of a Will, named trustees of a trust. Name Address Adult/Minor Relationship 17. Person Entitled to Notice. A request for Special Notice ( ) has ( ) has not been filed. If in the affirmative list name and address of person (1) requesting Special Notice: Name Address Adult/Minor Relationship

PR-E-LP-028

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 OPTIONAL PR-E-LP-028 (1.1.07) -7Final Account and Report of Conservator LOCAL RULE 15.100 ( ) Other (state proposed distribution & basis): (Name) (Address) (Identify item, amount, or percent) 18. Distribution of Property on Hand. Petitioner proposes to distribute the property on hand to (check applicable box): ( ) The personal representative, (_______________), of the deceased decedent's (Name) estate. ( ) The successors in interest as follows, because the deceased conservatee's estate subject to probate administrator does not exceed $100,000. (Name) (Address) (Identify item, amount, or percent)

PR-E-LP-028

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 OPTIONAL PR-E-LP-028 (1.1.07) -8Final Account and Report of Conservator LOCAL RULE 15.100 19. Conservator Fees and Costs. Petitioner requests fees as follows: ( ) Fees are waived or ( ) Not requested at this time. ( ) Fees are requested in the amount of $ ____________ Itemization of services set forth by date, time spent, & hourly rate are set forth in Exhibit "3". (Note: Exhibit "3" must include a statement of facts which must (1) show the nature and difficulty of tasks performed; (2) show the results achieved; (3) show the benefit of the services to the estate; (4) specify the amount requested for each category of service performed; (5) state the hourly rate of each person who performed services and the hours spent by each of them; (6) describe the services rendered in sufficient detail to demonstrate the productivity of the time spent. Petitioner requests: ( ) No Conservator Costs/Expenses ( ) Conservator Costs/Expenses advanced in the sum of $ ____________ be reimbursed. Itemization by date, amount, and purpose is set forth in Exhibit "3".

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20. Attorney Fees and Costs. (Note: Attorney must attach a separate verification in support of fees being requested) Petitioner requests attorney fees be approved as follows: ( ) Fees are waived or ( ) Not requested at this time. ( ) Fees are requested in the amount of $ ___________. Itemization of services set forth by date, time spent, & hourly rate are set forth in Exhibit "4". (Note: Exhibit "4" must include a statement of facts which must (1) show the nature and difficulty of tasks performed; (2) show the results achieved; (3) show the benefit of the services to the estate; (4) specify the amount requested for each category of service performed; (5) state the hourly rate of each person who performed services and the hours spent by each of them; (6) describe the services rendered in sufficient detail to demonstrate the productivity of the time spent. If the attorney fees requested include a paralegal acting under the direction and supervision of an attorney, then set forth in Exhibit 4 the following information: (1) Describe the qualifications of the paralegal (including education, certification, continuing education, and experience); (2) state the hours spent by the paralegal and the hourly rate requested for the paralegal's services; (3) describe the services performed by the paralegal; (4) state why it was appropriate to use the paralegal's services in the particular case; (5) demonstrate that the total amount requested for the extraordinary services of the attorney and the paralegal does not exceed the amount appropriate if the attorney had performed the services without the paralegal's assistance. Petitioner requests: ( ) No Attorney Costs/Expenses ( ) Attorney Costs/Expenses advanced in the sum of $ ____________ be reimbursed. Itemization by date, amount, and purpose is set forth in Exhibit "4".

OPTIONAL PR-E-LP-028 (1.1.07)

-9Final Account and Report of Conservator LOCAL RULE 15.100

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21. Compensation Paid from Conservatorship Estate to the Conservator or Attorney for Conservator without prior court order (Check applicable box): ( ) Conservator compensation ( ) was ( ) was not paid. ( ) Attorney fees ( ) were ( ) were not paid. If compensation or fees were paid, state: Date Amount To Whom Paid

22. Other (Add any additional information or actions by the conservator to be included in the report for which court approval is requested:

OPTIONAL PR-E-LP-028 (1.1.07)

-10Final Account and Report of Conservator LOCAL RULE 15.100

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WHEREFORE, petitioner requests that: 1. The within account and report be settled, allowed, and approved; 2. All acts and transactions as set forth in the account and report be approved; 3. The conservatorship be terminated. 4. Petitioner be authorized and directed to pay from the conservatorship estate to: ( ) petitioner the sum of $ ________ as compensation for conservator services rendered; ( ) petitioner costs advanced in the sum of $____________ during the period of this account; ( ) attorney ______________ the sum of $ ________ as compensation for (Name) legal services rendered; ( ) attorney ______________ costs advanced in the sum of $____________ during
(Name)

account. 5. After payment of all services ordered the above petitioner be authorized and directed to distribute the assets on hand as set forth in paragraph 18 of the petitioner. 6. Other (include additional requests not included above):

7. Petitioner be discharged as conservator upon application to the court after filing receipts of distribution. 8. For other orders as the court may deem proper. DATED: __________________________________________ Signature

OPTIONAL PR-E-LP-028 (1.1.07)

-11Final Account and Report of Conservator LOCAL RULE 15.100

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 OPTIONAL PR-E-LP-028 (1.1.07) -12Final Account and Report of Conservator LOCAL RULE 15.100 Sacramento, California. ________________________
(Signature)

VERIFICATION I, ___________________ declare:
(Petitioner Name)

I am the petitioner herein. I have read the foregoing account, report, and petition and the accompanying exhibits and schedules and know the contents and the same is true of my own knowledge except as to those matters which are therein stated upon my information and belief, and, as to those matters, I believe it to be true. The account contains a full statement of all charges against me and of all credits to which I am entitled on account of the estate during the period embraced in the account. Each item of expenditure therein set forth was actually paid out at the time and place and to the person as therein specifically state. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this verification was executed on ________, at
(Date)

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(NOTE: A separate Summary of Account with Schedules is required for the period beginning on the date of death of the Conservatee and ending on the last day of the accounting)

EXHIBIT "1" SUMMARY OF ACCOUNT CHARGES: Property on hand at beginning of account (or Inventories) Additional property received (or Supplemental Inventories) Receipts (Schedule A) Gains on Sale or Other Disposition (Schedule B) Net Income from trade or business (Schedule C) __________ __________ __________ __________

$__________

TOTAL CHARGES CREDITS:_ Disbursements (Schedule D) Losses on Sale or Other Disposition (Schedule E) Net loss from trade or business (Schedule F) Distributions (Schedule G) Property on hand at close of account (Schedule H)

*$__________ ________

$__________ __________ __________ __________ __________

TOTAL CREDITS:

*$__________

OPTIONAL PR-E-LP-028 (1.1.07)

-13Final Account and Report of Conservator LOCAL RULE 15.100

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*Total Charges should equal Total Credits

SCHEDULE A RECEIPTS

DATE

PAYEE AND PURPOSE

AMOUNT

Social Security

Retirement Income

Interest Income

Dividend Income

TOTAL: __________________ 28 OPTIONAL PR-E-LP-028 (1.1.07) -14Final Account and Report of Conservator LOCAL RULE 15.100

PR-E-LP-028

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 TOTAL: __________________ 28 OPTIONAL PR-E-LP-028 (1.1.07) -15Final Account and Report of Conservator LOCAL RULE 15.100 Other Receipts Rental Income DATE PAYEE AND PURPOSE AMOUNT SCHEDULE A RECEIPTS

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SCHEDULE B GAIN ON SALE OR OTHER DISPOSITION

Description of Property

Sales Price

Inventory Value

Gain on Sale

TOTAL: __________________ 28 OPTIONAL PR-E-LP-028 (1.1.07) -16Final Account and Report of Conservator LOCAL RULE 15.100

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SCHEDULE D DISBURSEMENTS

PAYEE AND PURPOSE

AMOUNT

Housing (Mortgage/Rent)

$

In-Home/Resident Care 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 OPTIONAL PR-E-LP-028 (1.1.07) TOTAL: __________________ Medication & Medical Supplies

-17Final Account and Report of Conservator LOCAL RULE 15.100

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 TOTAL: __________________ 28 OPTIONAL PR-E-LP-028 (1.1.07) -18Final Account and Report of Conservator LOCAL RULE 15.100 Credit Cards/Finance Co. Telephone Utilities Food DATE PAYEE AND PURPOSE AMOUNT SCHEDULE D DISBURSEMENTS

PR-E-LP-028

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 TOTAL: __________________ 28 OPTIONAL PR-E-LP-028 (1.1.07) -19Final Account and Report of Conservator LOCAL RULE 15.100 Bond Premiums Bank Fees Insurance Premiums Repairs & Maintenance DATE PAYEE AND PURPOSE AMOUNT SCHEDULE D DISBURSEMENTS

PR-E-LP-028

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 TOTAL: __________________ 28 OPTIONAL PR-E-LP-028 (1.1.07) -20Final Account and Report of Conservator LOCAL RULE 15.100 Miscellaneous Disbursements Administration Expenses & Fees Taxes Accounting & tax Service Fees DATE PAYEE AND PURPOSE AMOUNT SCHEDULE D DISBURSEMENTS

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SCHEDULE E LOSS ON SALE OR OTHER DISPOSITION

Description of Property

Sales Price

Inventory Value

Gain on Sale

TOTAL: __________________ 28 OPTIONAL PR-E-LP-028 (1.1.07) -21Final Account and Report of Conservator LOCAL RULE 15.100

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SCHEDULE G DISTRIBUTIONS

Address

Relationship

Item Distributed

TOTAL: __________________ 28 OPTIONAL PR-E-LP-028 (1.1.07) -22Final Account and Report of Conservator LOCAL RULE 15.100

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SCHEDULE H PROPERTY ON HAND Current Fair *Carry Value xxxxxxxx xxxxxxxx xxxxxxxx xxxxxxxx xxxxxxxx xxxxxxxx Market Value

(such as checking, savings, money markets, certificate of deposit) (state name of financial institution, account number, & amount of hand at end date of account period)

( ) Listed below (state common street address, legal description, how title is held, and interest held by the conservatee)

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*(value stated from last acct or if no acct from Inventory & Appraisal) SCHEDULE H PROPERTY ON HAND *Carry Value Current Fair Market Value 3. Stocks & Bonds: (List name of stock or identify the bond, # of shares, and value at end date of account)

4. Automobile (state year, make, and model)

5. Furniture & Personal Effects:

*(value stated from last acct or if no acct from Inventory & Appraisal) 28 OPTIONAL PR-E-LP-028 (1.1.07) -24Final Account and Report of Conservator LOCAL RULE 15.100

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SCHEDULE H PROPERTY ON HAND *Carry Value Current Fair Market Value

TOTAL:

$__________

$__________

*(value stated from last acct or if no acct from Inventory & Appraisal) 28 OPTIONAL PR-E-LP-028 (1.1.07) -25Final Account and Report of Conservator LOCAL RULE 15.100