Code § 2628 Mandatory Form SDSC Local Rule 4.15.11 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): TELEPHONE NO.: FAX NO. (Optional): EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, CENTRAL COURTHOUSE, 1100 UNION ST., SAN DIEGO, CA CENTRAL DIVISION, MADGE BRADLEY, 1409 4TH AVE., SAN DIEGO, CA IN THE MATTER OF DEPT ANNUAL DECLARATION RE WAIVER OF ACCOUNTINGS CASE NUMBER INSTRUCTIONS: This form is to be used when the court has previously ordered that future accountings in this proceeding are waived pursuant to Prob.

Code § 2628 and the circumstances still meet all of the following requirements:

(1) The estate at the beginning and end of this accounting period consisted of property, exclusive of the residence of the ward or conservatee, of a total net value of less than fifteen thousand dollars ($15,000);

(2) The income of the estate for each month of this accounting period, exclusive of public benefit payments, was less than two thousand dollars ($2,000); and

(3) A ll income of the estate duri ng this accounting period, if not retained, was spent for the benefit of the ward or conservatee. 1. I am the duly appointed conservator guardian of the estate in this proceeding. 2. The court entered an order on ____________ in this proceeding pursuant to Prob. Code § 2628 that I need not present an account so long as all of the conditions set forth in Prob. Code § 2628(

a) are satisfied. 3. This accounting period is from to . 4. The beginning net value of the estate for this accounting period, exclusive of the ward or conservatee’s residence, was $______________________. The ending net value of the estate for this accounting period, exclusive of the ward or conservatee’s residence, was $______________________. 5. The highest monthly income of the estate for this accounting period, exclusive of public benefit payments, was $______________________. 6. All income of the estate during the accounting period, if not retained, was spent for the benefit of the ward conservatee. 7.

I understand that I must file an accounting as required by Prob. Code § 2620 if all of the above requirements are not met. I further understand t hat a petition may be filed by the ward, conservatee, or any interested person, for an order to account, or the court on its own motion may order an accounting. Date: Signature of Attorney I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Type or print name Signature of Conservator/Guardian