Form Adopted for Mandatory Use
L-0703 (New April 11, 2019)
RESPONSE BY ELDERCARING COORDINATOR
ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NO.:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
CENTRAL JUSTICE CENTER
700 Civic Center Drive West
Santa Ana, CA 92701-4045
RESPONSE BY ELDERCARING COORDINATOR
I, (name) _______________________________________________, notify the Court and affirm the following:
1. Acceptance: (check one only)
I accept the appointment as Eldercaring Coordinator.
I decline the appointment as Eldercaring Coordinator.
2. Qualifications: (check one only)
I meet the qualifications as an Eldercaring Coordinator recommended by the Association for Conflict
Resolution Task Force on Eldercaring Coordination.
I do not meet the qualifications recommended by the Association for Conflict Resolution. However, the
parties have chosen me by mutual consent and I believe I can perform the services of an Eldercaring
Coordinator because:
3. I am not aware of any conflict, circumstance, or reason that renders me unable to serve as the Eldercaring
Coordinator in this matter and I will immediately inform the court and the parties if such arises.
4. I understand my role, responsibility, and authority under the Order Referring Parties to Eldercaring
Coordinator dated ____________ .
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
SIGNATURE OF ELDERCARING COORDINATOR
