Form Cc 16:2.5 - Address Information For Guardianships/ Conservatorships Page 2

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SPOUSE
Name
Nombre
Cónyuge:
Address
Domicilio
CHILDREN:
Name
Nombre
Age
Edad
Hijos:
Address
Domicilio
Name
Nombre
Age
Edad
Address
Domicilio
OTHER:
Name
Nombre
Relationship
Parentesco
Otro:
Address
Domicilio
Name
Nombre
Relationship
Parentesco
Address
Domicilio
INTERESTED PERSON(S)*: List the name(s) and address(es) of all interested persons* of the
ward/incapacitated person/protected person that are not listed above.
Persona(s) Interesadas*: Escriba el nombre(s) y domicilio(s ) de todas las personas
interesadas* que no están citadas arriba.
Name
Nombre
Address
Domicilio
Name
Nombre
Address
Domicilio
Name
Nombre
Address
Domicilio
Name
Nombre
Address
Domicilio
List the name(s) and address(es) of any person(s) authorized to manage the
ward’s/incapacitated person’s/protected person’s financial resources, if other than the
guardian(s)/conservator(s) signing below:
Escriba el nombre(s) y domicilio(s) de cualquier persona facultada para administrar los
recursos financieros del pupilo/persona incapacitada/inhábil, si es una persona diferente al
tutor(es)/curador(es) que suscribe a continuación:
Name
Nombre
Relationship
Parentesco
Address
Domicilio
Nature of power
Tipo de Facultad
 See attached (more names and addresses than above)
Vea los anexos (más nombres y domicilios que los arriba citados)
Page 2 of 4
Address Information for
Guardianships/Conservatorships
CC 16:2.5 Rev. 11/15

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