GC-355
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
AND ESTATE
OF
CONSERVATEE
CASE NUMBER:
DETERMINATION OF CONSERVATEE'S APPROPRIATE LEVEL OF CARE
DETERMINATION OF CONSERVATEE'S APPROPRIATE LEVEL OF CARE
(Probate—Guardianships and Conservatorships)
Form Adopted for Mandatory Use
Judicial Council of California
GC-355 [New July 1, 2011]
Probate Code, § 2352.5;
Cal. Rules of Court, rule 7.1063
www.courts.ca.gov
(Name):
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FAX NO. (Optional):
TELEPHONE NO.:
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
Page 1 of 4
CONSERVATORSHIP OF THE PERSON
as of (date):
On the date stated in item 1, the conservatee was living at the following residence or facility (address and name of facility, if any):
The conservatee has been living in the above residence or facility since (date):
(Name): , declares as follows:
2.
, the date of the order appointing me as conservator.
Telephone:
You must prepare a written determination of the conservatee's appropriate level of care, sign it under penalty of perjury, and file it
with the court within 60 days of the date of the court's order appointing you as conservator. You must use this form for that purpose.
Your determination must include an evaluation of the conservatee's level of care on the date the conservatorship proceeding was
started (the date the petition for the appointment of a conservator was filed with the court or, if more than one petition was filed, the
date the first petition was filed), and the measures that would be necessary to keep the conservatee in his or her personal
residence. If the conservatee was not living in that residence on the date the proceeding was started, your determination must
include either a plan to return the conservatee to that residence or an explanation of the reasons why the conservatee cannot return
to that residence in the foreseeable future. This determination is in addition to, not a replacement for, any written care or
placement plan the court may require. Check the court's local rules to see if a care or placement plan must also be filed.
The conservatee's personal residence is the residence he or she understood or believed, or appeared to understand or believe,
was his or her permanent residence on the date the conservatorship proceeding was started, whether or not he or she was living
there on that date. If the conservatee could not then form or communicate an understanding or belief about his or her permanent
residence, the conservatee's personal residence is the residence he or she last previously understood or appeared to understand
was his or her permanent residence. (See Cal. Rules of Court, rule 7.1063.)
a.
b.
I am conservator of the person of the above-named conservatee. I am determining the conservatee's appropriate level of care
1.
Notice to Conservator of the Person
.
To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when
finished.
