
CASE NUMBER:
CONSERVATEE
a.
b.
c.
Character and estimated value of the property of the estate (complete if a temporary conservatorship of the estate or the
person and estate is requested):
Petitioner requests authority to change the proposed conservatee's residence during the temporary conservatorship
a. Petitioner proposes to change the residence of the proposed conservatee to (address):
The proposed conservatee will suffer irreparable harm if his or her residence is not changed as requested and no means
less restrictive of the proposed conservatee's liberty will suffice to prevent the harm because (reasons are
specified in attachment 6a as follows):
The proposed conservatee must be removed from the State of California to permit the performance of the following
nonpsychiatric medical treatment essential to the proposed conservatee's physical survival. The proposed conservatee
b.
as follows):specified in attachment 6bconsents to this medical treatment. (Facts and place of treatment are
Petitioner is a professional fiduciary
GC-111 [New July 1, 2008]
PETITION FOR APPOINTMENT OF
TEMPORARY CONSERVATOR
(Probate—Guardianships and Conservatorships)
Page 2 of 3
pending the appeal under Probate Code section 1301.
GC-111
4.
5.
Annual gross income from all sources, including real and
personal property, wages, pensions, and public benefits:
a.
b.
Personal property:
c.
Total:
6.
7.
$
Temporary conservatorship is required
pending the hearing on the petition for appointment of a general conservator.
during the suspension of powers of the conservator.
TEMPORARY CONSERVATORSHIP OF
(Name):
b.
Petitioner holds license no. (specify):
of Consumer Affairs issued or last renewed on (specify later date of initial issuance or renewal):
from the Professional Fiduciaries Bureau of the Department
.
Petitioner was requested to file this petition by (name):
.
The circumstances leading to petitioner's engagement to file this petition are described in attachment 7c.
Petitioner had:
c.
d.
No relationship to the proposed conservatee, his or her family, or his or her friends before
engagement to file this petition.
(1)
(2) A relationship to the proposed conservatee, his or her family, or his or her friends before
engagement to file this petition. That relationship is described in
attachment 7d.
Petition for Appointment of Probate Conservator (form GC-310) filed with this petition or an
attachment to that petition (specify attachment to general petition):
the
a.
d.
Additional amount for cost of recovery on the bond, calculated as
required under Cal. Rules of Court, rule 7.207(c):
$
$
$