1 ATTORNEY OF RECORD: TO BE COMPLETED BY THE CONSERVATOR AND FILED THIRTY DAYS PRIOR TO THE GENERAL PLAN HEARING DATE. THE CONSERVATOR SHOULD RETAIN A COPY. SUPERIOR COURT OF CALIFORNIA COUNTY OF ALAMEDA Conservatorship of the ) Probate No. estate of ) ) CONSERVATORSHIP GENERAL PLAN ) ) conservatee) Date: Time: Department: , the conservator(

s) of the estate of hereby submits the conservator's General Plan in compliance with Local Court Rules. 1. Conservatee Information: Name: Date of Birth: Social Security Number: 2. Address: Telephone: 3. Conservatee's residence: own home/apartment skilled nursing home conservator's home/apartment board and care home hospital (medical/psychiatric) other (specify) How long has the Conservatee been in the present residence? Do you anticipate making any changes in the Conservatee's residence in the next year? No Yes (explain) 2 4. How often do you expect to visit the Conservatee? 5.

Do you plan to request conservator fees at the end of the first year? No Yes (anticipated amount of request) $ 6. Conservatee's Estimated Monthly Income Social Security/SSI $ Dividends $ Pension (source) $ Rental $ Veteran's benefits $ Interest $ Other (specify) $ Total Estimated Monthly Income $ 7. Conservatee's Estimated Monthly Expenses LIVING EXPENSES Rent/Mortgage $ Nursing/Care Home $ Food $ Medical/Dental $ Transportation $ Utilities $ In-home care $ Clothing $ Medications $ Entertainment $ Other (specify) $ Total Estimated Monthly Expenses $ 8.

Other Expenses TAXES Current Estimated Amount Income Tax Yes No $ Property Yes No $ Payroll Yes No $ INSURANCE Company Coverage Amount Estimated premium Homeowner ________ $ $ Renters $ $ Automobile $ $ 3 Worker's Comp $ $ Health $ $ Life $ $ Does the Conservatee receive Medi-Cal benefits? No Yes $ share of cost 9. Do you expect to sell any of the Conservatee’s real or personal property in the next year? No Yes If yes, explain why: 10. Does the conservatee own a home in which he/she does not live? No Yes. Is it rented? Amount of rent: $ If not rented explain why: 11.

If the conservatee’s monthly expenses are greater than monthly income, explain how the shortfall will be met: 12. Does the conservatee have a trust or is he/she entitled to receive income from a trust? If so, please provide an attachment with the name of the trust, any court case number for the trust, the name(s)of the trustee(s)and their contact information. _____________________________________________________________ 13. Do you anticipate any unusual activities related to the management of the conservatee's estate during the next year? No Yes (explain) 4 The undersigned conservator will: a.

Inventory all assets in which the conservatee has any interest; b. Render timely, accurate and complete accountings to the court; c. Carry out all mandatory usual and general duties of a conservator; d. Maintain accurate records related to the estate; e. Maintain all estate assets in a separate identifiable manner; f. Maintain estate cash assets in interest-bearing accounts, except as necessary for everyday administration; g. Maintain an adequate surety bond as required by law. h. Refer to the "Conservator's Handbook".

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that I have retained a copy of this case plan for my records. Dated: Signature of Conservator(

s) Type or print name(

s) Rev: 4/25; Ct. Inv.