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Here is the text we could read:

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

FOR COURT USE ONLY

GC-111

FAX NO. (Optional):

TELEPHONE NO.:

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

TEMPORARY CONSERVATORSHIP OF
(Name):

CASE NUMBER:

CONSERVATEE

PETITION FOR APPOINTMENT OF TEMPORARY CONSERVATOR

HEARING DATE:

Person

Estate

Person and Estate

DEPT.:

TIME:

Petitioner (name each):

requests that

(Address and
telephone number):
be appointed temporary conservator of the PERSON of the proposed conservatee and Letters issue upon qualification.

(Address and
telephone number):
be appointed temporary conservator of the ESTATE of the proposed conservatee and Letters issue upon qualification.

bond not be required because petition is for a temporary conservatorship of the person only.
bond not be required for the reasons stated in attachment 1c.
$
bond be fixed. It will be furnished by an admitted surety insurer or as otherwise provided by law.
(Specify reasons in attachment 1c if the amount is different from maximum required by Probate Code section 2320
and Cal. Rules of Court, rule 7.207(c).)
$
(Specify institution and location):

in deposits in a blocked account be allowed. Receipts will be filed.

a request for an exception to notice of the hearing on this petition for good cause is filed with this petition.

the powers specified in Attachment 1e be granted in addition to the powers provided by law.

other orders be granted (specify in attachment 1f).

2. The proposed conservatee is (name):

Current address:

Current telephone no.:

3. The proposed conservatee requires a temporary conservator to

provide for temporary care, maintenance, and support

protect property from loss or injury because (facts are

specified in attachment 3

as follows):

(Name):

(1)
(2)
(3)

(4)

e.
f.

Form Adopted for Mandatory Use
Judicial Council of California
GC-111 [New July 1, 2008]

PETITION FOR APPOINTMENT OF
TEMPORARY CONSERVATOR
(Probate—Guardianships and Conservatorships)

Page 1 of 3

Probate Code, § 2250;
Cal. Rules of Court, rules 7.101, 7.1062

TEMPORARY CONSERVATORSHIP OF
(Name):

4. Temporary conservatorship is required

CASE NUMBER:

CONSERVATEE

GC-111

a.
b.
c.

pending the hearing on the petition for appointment of a general conservator.
pending the appeal under Probate Code section 1301.
during the suspension of powers of the conservator.

Character and estimated value of the property of the estate (complete if a temporary conservatorship of the estate or the
person and estate is requested):

$ $ $ $

a. Personal property:
b. Annual gross income from all sources, including real and
personal property, wages, pensions, and public benefits:

c. Additional amount for cost of recovery on the bond, calculated as

required under Cal. Rules of Court, rule 7.207(c):

d. Total:

Petitioner requests authority to change the proposed conservatee's residence during the temporary conservatorship

(address):
Petitioner proposes to change the residence of the proposed conservatee to

The proposed conservatee will suffer irreparable harm if his or her residence is not changed as requested and no means
less restrictive of the proposed conservatee's liberty will suffice to prevent the harm because (reasons are

specified in attachment 6a

as follows):

The proposed conservatee must be removed from the State of California to permit the performance of the following
nonpsychiatric medical treatment essential to the proposed conservatee's physical survival. The proposed conservatee
consents to this medical treatment. (Facts and place of treatment are

specified in attachment 6b

as follows):

(2)

A relationship to the proposed conservatee, his or her family, or his or her friends before
engagement to file this petition. That relationship is described in
Petition for Appointment of Probate Conservator (form GC-310) filed with this petition or an
attachment to that petition (specify attachment to general petition):

attachment 7d.

the

from the Professional Fiduciaries Bureau of the Department

of Consumer Affairs issued or last renewed on (specify later date of initial issuance or renewal):

b. Petitioner was requested to file this petition by (name):
c.

The circumstances leading to petitioner's engagement to file this petition are described in attachment 7c.

d. Petitioner had: (1)

No relationship to the proposed conservatee, his or her family, or his or her friends before
engagement to file this petition.

Petitioner is a professional fiduciary

a. Petitioner holds license no. (specify):

GC-111 [New July 1, 2008]

Page 2 of 3

PETITION FOR APPOINTMENT OF
TEMPORARY CONSERVATOR
(Probate—Guardianships and Conservatorships)

GC-111

TEMPORARY CONSERVATORSHIP OF
(Name):

CASE NUMBER:

CONSERVATEE

8. Petitioner's contact with persons named in Petition for Appointment of Probate Conservator

Petitioner is the proposed conservatee. (If this item is selected, go to item 9.)

Petitioner is not the proposed conservatee. All persons other than the proposed conservatee named in the Petition for
Appointment of Probate Conservator filed with this petition:

(1)

(2)

Have been found and contacted. All will be given notice of the hearing on this petition.

Have not been found or have not been contacted. Efforts to find the persons who have not been found and
the reasons why any person cannot be contacted are described in one or more declarations under penalty of
perjury attached to this petition as attachment 8b. (Attachment 8b is not a request for a good cause exception
to notice. See Prob. Code, § 2250(e) and rule 7.1062 of the Cal. Rules of Court.)

Petitioner is not the proposed conservatee. Facts showing the preferences of the proposed conservatee concerning the
appointment of any temporary conservator, and the appointment of the temporary conservator proposed in this petition,
or why it was not feasible to ascertain those preferences, are specified in one or more declarations attached to this
petition as attachment 8c.

9. Petitioner is informed and believes that the proposed conservatee

will attend the hearing.
is able but unwilling to attend the hearing, does not wish to contest the establishment of a conservatorship, does not
object to the proposed conservator, and does not prefer that another person act as conservator.
is unable to attend the hearing because of medical inability. An affidavit or certificate of a licensed medical
practitioner or an accredited religious practitioner is affixed as attachment 9c.
is not the petitioner, is out of state, and will not attend the hearing.

10.

Filed with this petition is a proposed Order Appointing Court Investigator (form GC-330).

11. All attachments to this form are incorporated by this reference as though placed here in this form. There are

pages

attached to this form.

* (Signature of all petitioners also required (Prob. Code, § 1020).)

(SIGNATURE OF ATTORNEY*)

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

(TYPE OR PRINT NAME)

(SIGNATURE OF PETITIONER)

(TYPE OR PRINT NAME)

(SIGNATURE OF PETITIONER)

a.
b.

Date:

GC-111 [New July 1, 2008]

Page 3 of 3

PETITION FOR APPOINTMENT OF
TEMPORARY CONSERVATOR
(Probate—Guardianships and Conservatorships)

Petition For Appointment of Temporary Conservator

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 3
Fields(s): 87
Average fields per page: 29
Reading Level: Grade 11
LIST Grouping(s): HO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

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c_page_p_caption_info_street was GC-111[0].Page1[0].P1Caption[0].CourtInfo[0].CrtStreet[0] (0.36 conf)
page_p_caption_court_info_mailing was GC-111[0].Page1[0].P1Caption[0].CourtInfo[0].CrtMailingAdd[0] (0.41 conf)
c_page_p_caption_court_info was GC-111[0].Page1[0].P1Caption[0].CourtInfo[0].CrtBranch[0] (0.36 conf)
g_c_page_p_caption_court_info_crt_city_zip was GC-111[0].Page1[0].P1Caption[0].CourtInfo[0].CrtCityZip[0] (0.35 conf)
c_page_p_form_title_name was GC-111[0].Page1[0].P1Caption[0].FormTitle[0].Name1[0] (0.39 conf)
g_c_page_p_case_number was GC-111[0].Page1[0].P1Caption[0].CaseNumber[0].CaseNumber[0] (0.37 conf)
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c_page_p_form_title_area__2 was GC-111[0].Page1[0].P1Caption[0].FormTitle1[0].#area[1].Ch1[1] (0.39 conf)
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c_page_p_party_info_email was GC-111[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Email[0] (0.39 conf)
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c_page_p_number_text_field__2 was GC-111[0].Page1[0].P1Caption[0].CaseNumber2[0].TextField[1] (0.43 conf)
g_c_page_date__1 was GC-111[0].Page1[0].on_date[0] (0.32 conf)
g_c_page_text_field__1 was GC-111[0].Page1[0].TextField[0] (0.41 conf)
g_c_page_text_field__2 was GC-111[0].Page1[0].TextField[1] (0.41 conf)
g_c_page_text_field__3 was GC-111[0].Page1[0].TextField[2] (0.41 conf)
g_c_page_text_field__4 was GC-111[0].Page1[0].TextField[3] (0.41 conf)
g_c_page_area_petitioner_cb__1 was GC-111[0].Page1[0].#area[0].petitioner_cb[0] (0.32 conf)
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g_c_page_area_decimal_field__2 was GC-111[0].Page1[0].#area[3].DecimalField6[0] (0.35 conf)
g_c_page_text_field__5 was GC-111[0].Page1[0].TextField[4] (0.41 conf)
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g_c_page_text_field__7 was GC-111[0].Page1[0].TextField[6] (0.41 conf)
g_c_page_text_field__8 was GC-111[0].Page1[0].TextField3[0] (0.41 conf)
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g_c_page_area_check_box__18 was GC-111[0].Page2[0].#area[8].#area[10].CheckBoxCaption[8] (0.35 conf)
g_c_page_text_field__11 was GC-111[0].Page2[0].TextField[2] (0.41 conf)
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g_c_page_text_field__12 was GC-111[0].Page2[0].TextField[3] (0.41 conf)
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g_c_page_text_field__14 was GC-111[0].Page2[0].TextField[5] (0.41 conf)
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g_c_page_area_check_box__28 was GC-111[0].Page3[0].#area[4].CheckBox19[2] (0.37 conf)
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We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Petition For Appointment of Temporary Conservator

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02