Contact Information Pursant To Probate Code {GC-11}

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar No., Address) FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA COURT ADDRESS: 725 Court Street CITY AND ZIPCODE: Martinez, California 94553 PHONE NUMBER: (925) 957-7970 FAX NUMBER: (925) 957-7979 BRANCH NAME: Court Investigator's Unit CONSERVATORSHIP OF THE PERSON ESTATE OF: CASE NUMBER: CONTACT INFORMATION PURSUANT TO PROBATE CODE §2250.6(a)(1)(A)(B)(C), §1826(a)(1)(2), §1851(a) - CONFIDENTIAL - HEARING DATE: [ ] Initial Petition for Appointment [ ] Review [ ] Petition for Successor Conservator General Directions This form must be filed with petitions for the appointment of a conservator, for appointment of a successor conservator, and with subsequent accountings. Add pages if necessary to give complete information. GC-11 / Effective 11-02-07 CONTACT INFORMATION PURSUANT TO PROBATE CODE §2250.6(a)(1)(A)(B)(C), §1826(1)(2), §1851(a) - CONFIDENTIAL - 1 American LegalNet, Inc. www.FormsWorkflow.com 1. [ ] (Proposed) Conservatee [ ] Conservatee Name Address City, State and Zip _______________________________ Day Program (if appropriate) Telephone Number: ______________________ Residence SPECIAL PROBLEMS RELATED TO INVESTIGATION (i.e. language, personal safety, communication) NOTE: The Court must be notified immediately of address changes of Conservatees and Conservators. 2. Petitioner (if different from Proposed Conservator) Name Address City, State and Zip Home Number Work Number Cell Number Relationship to (Proposed Conservatee): 3. [ ] Conservator [ ] Proposed Conservator [ ] Proposed Successor Conservator Name Address City, State and Zip Home Number Work Number Cell Number Relationship to (Proposed Conservatee): 4. (Proposed) Conservatee's Spouse or Registered Domestic Partner _______ Spouse _______ Registered Domestic Partner Name Address City, State and Zip Home Number Work Number Cell Number GC-11 / Effective 11-02-07 CONTACT INFORMATION PURSUANT TO PROBATE CODE §2250.6(a)(1)(A)(B)(C), §1826(1)(2), §1851(a) - CONFIDENTIAL - 2 American LegalNet, Inc. www.FormsWorkflow.com 5. (Proposed) Conservatee's Relatives within the First Degree (Adult Children, Parents) Name Address City, State and Zip Home Number Work Number Cell Number Relationship to (Proposed Conservatee): Name Address City, State and Zip Home Number Work Number Cell Number Relationship to (Proposed Conservatee): Name Address City, State and Zip Home Number Work Number Cell Number Relationship to (Proposed Conservatee): 6. (Proposed) Conservatee's Relatives within the Second Degree (Grandparents, Adult Grandchildren, Sisters and Brothers) Name Address City, State and Zip Home Number Work Number Cell Number Relationship to (Proposed Conservatee): Name Address City, State and Zip Home Number Work Number Cell Number Relationship to (Proposed Conservatee): GC-11 / Effective 11-02-07 CONTACT INFORMATION PURSUANT TO PROBATE CODE §2250.6(a)(1)(A)(B)(C), §1826(1)(2), §1851(a) - CONFIDENTIAL - 3 American LegalNet, Inc. www.FormsWorkflow.com Name Address City, State and Zip Home Number Work Number Cell Number Relationship to (Proposed Conservatee): 7. (Proposed) Conservatee's Relatives Name Address City, State and Zip Home Number Work Number Cell Number Relationship to (Proposed Conservatee): Name Address City, State and Zip Home Number Work Number Cell Number Relationship to (Proposed Conservatee): 8. (Proposed) Conservatee's Neighbors Name Home Number Work Number Cell Number Name Home Number Work Number Cell Number 9. (Proposed) Conservatee's Close Friends Name Home Number Work Number Cell Number Name Home Number Work Number Cell Number GC-11 / Effective 11-02-07 CONTACT INFORMATION PURSUANT TO PROBATE CODE §2250.6(a)(1)(A)(B)(C), §1826(1)(2), §1851(a) - CONFIDENTIAL - 4 American LegalNet, Inc. www.FormsWorkflow.com