Conservatorship_Guardianship Questionnaire

Law Offices of Cheryl L. Walsh, APC
27282 Calle Arroyo, Suite 200
San Juan Capistrano, CA 92675

Phone: (949) 240-9003 Fax: (949) 240-9083

Cheryl@WalshSeniorLaw.com
A. PROPOSED CONSERVATEE/WARD INFORMATION:
Full name of Proposed Conservatee ("PC")/Ward ("W"):
Current address of PC/W:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Current Phone # of PC/W:

Area CodePhone Number
Need to Relocate PC/W?
Proposed new address for PC/W:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
PC/W Date of Birth:
PC/W Social Security #:
PC/W Driver's License #:
Will PC/W be able to attend court hearing?
Name, address & telephone # of PC/W's regular physician/psychiatrist:

Were health services provided to PC/W during the past year?
If yes, please explain:
Was estate management assistance provided to the PC within the past year?
If no, please explain:
Do you want to request a Conservatorship over the person?
Do you want to request a Conservatorship over the estate?

B. PETITIONER INFORMATION
Name of Petitioner:
Relationship of Petitioner to PC/W:
Name address, and telephone # of Petitioner:
Relationship of Petitioner to PC/W?
Date of birth of Petitioner:

C. CONSERVATOR/GUARDIAN INFORMATION:
Conservator/Guardian's Name, address and telephone #:
Conservator/Guardian's Date of Birth:
Conservator/Guardian's Social Security Number:
Conservator/Guardian's Driver License #:
D. FACTS SUPPORTING CONSERVATORSHIP/GUARDIANSHIP:
Reasons Conservatorship/Guardianship is required: (Explain why you believe a Conservatorship is necessary and appropriate).
Is a temporary Conservatorship/Guardianship required immediately?
Why is a Temporary Conservatorship/Guardianship required immediately? What is the imminent harm that would result if the conservatorship is not established immediately?

Current Value of Estate:
List all assets & approximate value of each:
Total Monthly Income:
Source of Income #1:
Amount:
Source of Income #2:
Amount:
Source of Income #3:
Amount:
Source of Income #4:
Amount:
Dated:
Completed by:
Should be Empty: