
CONFIDENTIAL
CASE NUMBER:
CONSERVATORSHIP OF (Name):
PROPOSED CONSERVATEE
not living in his or her residence and(2)
(specify supporting facts below in item 4c(3)).will return by (date):(a)
will not return to live there (specify supporting facts below in item 4c(3)).
other (specify and give supporting facts below in item 4c(3)).
(b)
(c)
Specified in Attachment 4c.Supporting facts (specify if required):(3)
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.
Voluntary acceptance of informal or formal assistance (give reason this is unsuitable or unavailable):
Special or limited power of attorney (give reason this is unsuitable or unavailable):
General power of attorney (give reason this is unsuitable or unavailable):
Durable power of attorney for health care estate management (give reason this is unsuitable or unavailable):
Trust (give reason this is unsuitable or unavailable):
Other alternatives considered (specify and give reason each is unsuitable or unavailable):
Page three of four
SERVICES PROVIDED* (complete a or b, or both a and b)
During the year before this petition was filed,a.
were not provided to the proposed conservatee (explain):health services were provided
Explained in Attachment 6a(1).
were not provided to the proposed conservatee (explain):social services were provided
Explained in Attachment 6a(2).
4.
5.
a.
b.
c.
(Continued on page four)
CONFIDENTIAL SUPPLEMENTAL INFORMATION
(Probate Conservatorship)
GC-312 [Rev. January 1, 2001]
* If this item is not applicable, complete item 8.
d.
e.
f.
6.
(1)
(2)
(continued)c.