ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
TELEPHONE NO.:
FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
CONSERVATORSHIP OF
Person
Estate
(Name):
CASE NUMBER:
REQUEST FOR DEFERMENT OF COURT INVESTIGATOR FEE AND ORDER
I am (we are) now the duly appointed, qualified, and acting conservator(s) of the person and/or estate of said
conservatee.
I am (we are) requesting a deferment of the Court Investigator fee ordered to be paid in this matter. The payment
of said fee would create a hardship to the conservatee and/or their estate. The request for deferment is based on
the following information about the conservatee’s assets:
1. The conservatee
is
is not receiving Medi-Cal benefits.
2. The conservatee’s monthly income is $_________________.
3. The conservatee’s liquid assets, i.e. cash, are currently valued at $_________________.
4.
The conservatee
owns
does not own any real interest in real property.
5.
The conservatee
is not the beneficiary of a trust. The conservatee
is the beneficiary of a trust.
The conservatee’s financial interest in the trust is valued at $ _______________
I understand that I have a duty to notify the court of any changes to the conservatee’s circumstances that may
affect the eligibility for a deferment of fees.
I declare under the penalty of perjury under the laws of the State of California that the foregoing
is true and correct.
Date: _____________________
___________________________________
____________________________________________
(TYPE OR PRINT NAME OF CONSERVATOR(S)
(SIGNATURE OF CONSERVATOR(S)/
_______________________________________________________________________________________
BASED ON THE FOREGOING INFORMATION, THE COURT INVESTIGATOR FEE IS ORDERED:
Deferred and is payable upon the conservatee’s death or liquidation of property.
Other ______________________________________________________________________.
Date: __________________
Signature: __________________________________
Judicial Officer
_______________________________________________________________________
REQUEST FOR DEFERMENT OF COURT INVESTIGATOR FEE AND ORDER
Form SB-1050 (02/12)
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