Fillable ATTACHMENT PB-4002 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (The Superior Court of California, County of Santa Clara)

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ATTACHMENT PB-4002 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (The Superior Court of California, County of Santa Clara)

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ATTACHMENT PB-4002
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address): TELEPHONE NUMBER:
EMAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
191 North First Street
191 North First Street
San José, California 95113
Downtown Courthouse - Probate Division
FOR COURT USE ONLY
Conservatorship of (Name):
Person Estate Limited
Temp Hrg Date:
Perm Hrg. Date:
REFERRAL FOR COURT INVESTIGATOR -
CONSERVATORSHIP
CASE NUMBER:
Note: A fee may be assessed for Court Investigator Services – See Probate Code § 1851.5
This Referral is being sent to the Probate Investigator’s Office for an investigation regarding (check all that apply):
Appointment Accounting/Review Termination
Medical Powers Dementia Powers Other: (specify):
Sale of (former) Residence Substituted Judgment
Information about the (Proposed) CONSERVATEE
(Proposed) Conservatee’s CURRENT address:
Address:
Phone number:
(Proposed) Conservatee’s HOME address:
Address:
Phone number:
Birth Date:
Social Security number:
Marital Status:
Single/Divorced Widowed Married Registered Domestic Partner
Special needs (i.e. language)?
Is (proposed) conservatee under an LPS Conservatorship now?
Yes No
If
yes, LPS #
(Proposed) Conservatee’s Attorney (name):
Address:
Phone number:
Fax number:
PB-4002 REV 1/1/08
REFERRAL FOR COURT INVESTIGATOR - CONSERVATORSHIP
(PROBATE – SANTA CLARA COUNTY)
Page 1 of 5
www.courtinfo.ca.gov
CONFIDENTIAL
– DO NOT PUT IN COURT FILE
To keep other people from
seeing what you have entered,
please press the Reset Form
button at the end of this form
when finished.
ATTACHMENT PB-4002
Conservatorship of (Name):
Case Number:
General Hearing Date:
Information about the (Proposed) CONSERVATOR
All
proposed Conservators must complete the information on this page. If there is more
than one proposed Conservator, attach a copy of this page for each person.
Name:
Relationship to Conservatee:
Spouse Son/Daughter Registered Domestic Partner
Other (describe):
Home Address:
Home phone:
Fax number:
Birth Date:
Social Security number:
Driver’s License number:
Work phone:
Cell phone:
(Proposed) Conservator’s Attorney (name):
Address:
Phone number: Fax number:
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
Signature of Proposed Conservator
Information sheet(s) for (number) of (proposed) co-conservators is attached.
PB-4002 REV 1/1/08
REFERRAL FOR COURT INVESTIGATOR - CONSERVATORSHIP
(PROBATE – SANTA CLARA COUNTY)
Page 2 of 5
www.courtinfo.ca.gov
CONFIDENTIAL – DO NOT PUT IN COURT FILE
ATTACHMENT PB-4002
Conservatorship of (Name):
Case Number:
General Hearing Date:
Information about (Proposed) Conservatee’s Relatives & Friends
List the spouse or registered domestic partner, 1
st
and 2
nd
degree relatives (these are parents,
children, brothers/sisters, grandparents and grandchildren), neighbors and close friends of the
(proposed) conservatee.
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
PB-4002 REV 1/1/08
REFERRAL FOR COURT INVESTIGATOR - CONSERVATORSHIP
(PROBATE – SANTA CLARA COUNTY)
Page 3 of 5
www.courtinfo.ca.gov
CONFIDENTIAL – DO NOT PUT IN COURT FILE
ATTACHMENT PB-4002
Conservatorship of (Name):
Case Number:
General Hearing Date:
Information about (Proposed) Conservatee’s Relatives & Friends
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
PB-4002 REV 1/1/08
REFERRAL FOR COURT INVESTIGATOR - CONSERVATORSHIP
(PROBATE – SANTA CLARA COUNTY)
Page 4 of 5
www.courtinfo.ca.gov
CONFIDENTIAL – DO NOT PUT IN COURT FILE
ATTACHMENT PB-4002
Conservatorship of (Name):
Case Number:
General Hearing Date:
Information about OTHER ADULTS (age18 or older) who reside with the proposed Conservatee
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
Name:
Relationship to (proposed) conservatee:
Home Address:
Home phone: Work phone: Cell phone:
Name:
Relationship to (proposed) conservatee:
Home Address:
PB-4002 REV 1/1/08
REFERRAL FOR COURT INVESTIGATOR - CONSERVATORSHIP
(PROBATE – SANTA CLARA COUNTY)
Page 5 of 5
www.courtinfo.ca.gov
CONFIDENTIAL
– DO NOT PUT IN COURT FILE
Home phone: Work phone: Cell phone:
Home phone: Work phone: Cell phone:
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ATTACHMENT PB-4002 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (The Superior Court of California, County of Santa Clara)

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Completed 29 June 2021

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