Confidential Regional Center Report {PR027}

ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME, STATE BAR NUMBER AND ADDRESS) FOR COURT USE ONLY TELEPHONE NUMBER: FAX NO. (Optional): EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN LUIS OBISPO STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: 1035 Palm Street, Room 385 Same as above San Luis Obispo, CA 93408 San Luis Obispo Division LIMITED CONSERVATORSHIP OF: CASE NUMBER: Date: Time: Dept: *CONFIDENTIAL* REGIONAL CENTER REPORT-Probate Code §1827.5 *In the case of a Limited Conservatorship Petition, pursuant to Probate Code §1827.5, the Regional Center shall assess the limited conservatee at the Regional Center and submit a written report of its findings and recommendations to the Court. Petitioner: Submit this form to the Regional Center at least thirty (30) days before your hearing date. Regional Center: This form must be filed and mailed at least five (5) days prior to the hearing date noted above on the parties listed in Probate Code §1827.5. [PETITIONER- COMPLETE FOLLOWING]: 1. A Petition has been filed to establish a limited conservatorship over the proposed limited conservatee (name)_______________________________. The Petition has been filed by (name)_____________________________________ (relationship to conservatee) ___________________________________________________________________. Form Adopted for Optional Use San Luis Obispo Superior Court Local Form PR027 Rev. 1/1/16 CONFIDENTIAL REGIONAL CENTER REPORT Probate Code § 1827.5 American LegalNet, Inc. www.FormsWorkFlow.com LIMITED CONSERVATORSHIP OF: CASE NUMBER [REGIONAL CENTER COMPLETE FOLLOWING]: 2. Describe the "specific areas, nature and degree of disability of the proposed limited conservatee" below. Probate Code §1827.5(c). ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ __________________________________________________________________. 3. Based on the information provided to the Regional Center: (mark either box a or b). a. The Petitioner is included in one of the following categories (mark applicable box). i. Is NOT a provider of board and care, treatment, habilitation, or other services to developmentally disabled persons, or is a spouse or employee of a provider; OR ii. iii. b. Is the natural parent of the proposed limited conservatee; OR Is a public entity. The Petitioner is not included in one of the categories under 3.a. i-iii. (Complete item 3.c). c. If the Petitioner is not one of categories under item 3.a, the Regional Center's report must include a recommendation concerning the Petitioner's suitability as a limited conservator. (Probate Code §§1461.4(b), 1827.5(c)) (if applicable, please provide recommendation below or on attachment 3.c.). ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ __________________________________________________________________. Form Adopted for Optional Use San Luis Obispo Superior Court Local Form PR027 Rev. 1/1/16 CONFIDENTIAL REGIONAL CENTER REPORT Probate Code § 1827.5 American LegalNet, Inc. www.FormsWorkFlow.com LIMITED CONSERVATORSHIP OF: CASE NUMBER 4. The proposed limited conservatorship is: Recommended for approval. Not recommended for approval. Other (please explain below or on attachment 4): ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ __________________________________________________________________. 5. The powers requested by the Petitioner are: Recommended for approval. Not recommended for approval. Other (please explain below or on attachment 5): ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ __________________________________________________________________. 6. Other Comments (please explain below or on attachment 6). ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ _________________________________________________________________. I declare under penalty of perjury under the laws of the State of California, that the foregoing is true and correct. Date: ______________________________________ (Signature ) _______________________________________ (Title) Form Adopted for Optional Use San Luis Obispo Superior Court Local Form PR027 Rev. 1/1/16 CONFIDENTIAL REGIONAL CENTER REPORT Probate Code § 1827.5 American LegalNet, Inc. www.FormsWorkFlow.com