On January 11, 2017 a
Letter,Correspondence
was filed
involving a dispute between
and
for Conservatorship of Person & Estate
in the District Court of Butte County.
Preview
’1 JAN 1 I ZUI7
I
GC-350
ATTORNEY OR PARTY WITHOUT ATTORNEY (name, address, and State Bar number):
After recording return to:
BUTTE COUNTY COUNSEL-SPECIAL COUNSEL
TAHJ GOMES, Esq. SBN 205254
PO. BOX 1649
Oroville, CA 95965
TEL N0.: (530) 387-5150 FAX NO. (oplional): (530) 538-7722
ADDRESS (optional):
E—MAIL
BUTTE COUNTY PUBLIC
ATTORNEY FOR (name): GUARDIAN
BUTTE COUNTY
SUPERIOR COURT OF CAUFORNIA. COUNTY OF
STREET ADDRESS:1775 Concord Avenue
1775 Concord Avenue
MAILING ADDRESS:
N
Chico, CA
CITY AND ZIP CODE: 95928
BRANCH NAME: Probate Department FOR RECORDER‘S USE ONLY
CONSERVATORSHIP OF (name): CASE NUMBER:
KIRKLAND PEIRSON
CONSERVATEE 17PRGOG4Q
FOR COURT USE ONLY
LETTERS OF CONSERVATORSHIP
[El Person El Estate El Limited Conservatorship ‘
Superior oUunur udlllOfnla
1. E (Name):
E
BUTTE COUNTY PUBLIC GUARDIAN
conservator
of (name):
D
KIRKLAND
limitedconservator
PEIRSON
of the EIperson
is the appointed
Elestate I
I.
Cmmtvof Butte .~
ml"~—-T
APR 04
2. D (For conservatorship that was on December 31, 1980, a guardianship of an adult or of E 2017
the person of a mam’ed minor) (Name):
was appointed the guardian of the D person CI estate by order dated
D KI I ner,ClerI\
D
By,
(specify): and is now the conservator of the D person Depul'
CI estate of (name):
3. E Other powers have been granted or conditions imposed as follows:
a. E] Exclusive authority to give consent for and to require the conservatee to receive
medical treatment that the conservator in good faith based on medical advice
determines to be necessary even if the conservatee objects. subject to the limitations
stated in Probate Code section 2356.
(1) C] This treatment shall be performed by an accredited practitioner of the religion whose tenets and practices call
for reliance on prayer alone for healing of which the conservatee was an adherent prior to the establishment of
the conservatorship.
(2) D (If court order limits duration) This medical authority terminates on (date):
b. D Authority to place the conservatee in a care or nursing facility described in Probate Code section 2356.5(b).
c. CI Authority to authorize the administration of medications appropriate for the care and treatment of dementia described in
Probate Code section 2356.5(c).
d. C] Powers to be exercised independently under Probate Code section 2590 are specified in Attachment 3d (specify powers,
and limitations).
restrictions, conditions,
e. D Conditions relating to the care and custody of property under Probate Code section 2402 are specified in Attachment 3e.
f. D Conditions relating to the care, treatment, education,
are specified in Attachment 3f.
and welfare of the conservatee under Probate Code section 2358
9. a (For limited conservatorship only) Powers of the limited conservator of the person underProbate Code section 2351.5 are
specified in Attachment 39.
h. D (For limited conservatorship only) Powers of the limited conservator of the estate under Probate Code section
specIf ed in Attachment 3h.
1830(b) are
4. D The conservator Isnot authorized to take possession of money or any other property without
specific court order.
a
5. Number of pages attached: 1
WlTl:lER§Rckifk‘ff£t1 ’ourt, with seal of the court affixed.
ER
.Deputy Page1of 2
nservatorshlp of the estate as provlded ln Probate Code §1875.
§ 1834
Probate Code.
Fun-n Ado ted tor Mandatory Use LETTERS OF CONSERVATORSHIP 90-;2893
Code of Clvll Procedurzea. § 2015 6
Martin Dean's
Judicia Council of California
GC-350 (Rev. July 1. 2015] m (Probate-Guardianships and Conservatorships) www.courts.ca.gov
ESSENTIAl FflRMS
BUTTE COUNTY PUBLIC GUARDIAN
GC-350
CONSERVATORSHIP OF (name): CASE NUMBER:
KIRKLAND PEIRSON _
CONSERVATEE
NOTICE TO INSTITUTIONS AND FINANCIAL INSTITUTIONS
(Probate Code sections 2890-2893)
When these Letters of Conservatorship (Letters) are delivered to you as an employee or other representative of an institution or
financial institUtion (described below) in order for the conservator of the estate (1) to take possession or control of an asset of the
conservatee named above held by your institution (including changing title, withdrawing all or any portion of the asset, or transferring all
or any portion of the asset) or (2) to open or change the name of an account or a safe-deposit box in your financial institution to reflect
the conservatorship, you must fill out Judicial Council form 60-050 (for an institution) or form 60-051(for a financial institution). An
officer authorized by your institution or financial institution must date and sign the form, and you must file the completed form with the
court.
There is no filing fee for filing the form. You may either arrange for personal delivery of the form or mail it to the court for filing at the
address given for the court on page 1 of these Letters.
The conservator should deliver a blank copy of the appropriate form to you with these Letters, but it is your institution's or financial
institution’s responsibility to complete the correct form, have an authorized officer sign it, and file the completed form with the court. If
the correct form is not delivered with these Letters or is unavailable for any other reason, blank copies of the forms may be obtained
from the court. The forms may also be accessed from the judicial branch' s public Web site free of charge. The Internet address (URL) is
w. courts. ca. gov/fonns/. Select the form group Probate—Guardianships and Conservatorships and scroll down to form GC- 050 for
an institution or form 60- 051for a financial institution. The forms may be printed out as blank forms and filled In by typewriter or may be
filled out online and printed out ready for signature and filing.
An institution under California Probate Code section 2890(0) is an insurance company, agent, or broker; an investment company; an
investment bank; a securities broker-dealer; an investment advisor; a financial planner; a financial advisor; or any other person who
takes, holds Institutions must file a
or controls an asset subject to a conservatorship or guardianship other than a financial institution.
Notice of Taking Possession or Control of an Asset of Minor or Conservatee (form GC--050) for an asset ofthe conservatee held by the
institution.
institution. A single form may be filed for all affected assets held by the
A financial institution under California Probate Code section 2892(b) Is a bank. a trust, a savings and loan association, a savings bank,
an industrial bank, or a credit union. Financial institutions must file a Notice of Opening or Changing a Guardianship or Conservatorship
W}
Account or Safe-Deposit Box (form GC- 051) for an account or a safe-deposit box held by the financial institution. A single form may be
filed for all affected accounts or safe-deposit boxes held by the financial institution.
LE'I'I'ERS OF CONSERVATORSHIP
AFFIRMATION
lsolemnly affirm that I will perform according to law the duties of IE] conservator D limited conservator.
Executed on (date): xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx ,at (place):Refer to Probate Code Section 2922(b)
(TYPE0R PRINT NAME) (SIGNATUREor APPOINTEE)
CERTIFICATION
Icertify that this document,including any attachments, is a correct copy of the original on file in my office, and that the Letters issued to
the person appointed above have notbeen revoked, annulled, or set aside, and are still in full force and effect.
(SEAL)
Date:
Clerk, by ,Deputy
Gcsso LETTERS 0F CONSERVATORSHIP PageZof2
[Rev. July 1. 2015]
Marlin Dean‘s (Probate-Guardianships and Conservatorships)
ESSENTIAL FIIRMSj“ . BUTTE COUNTY PUBLIC GUARDIAN
ATTACHMENT 3i
1. Conservator has authorization for the care, custody and control of, and for
charge of the education of the Conservatee pursuant to Probate Code
\OOOVQM-wu—a
§2351 (a).
2. Pursuant to Probate Code §2352, Conservator has the authority to fix the
residence of the Conservatee at:
(a) Any place within the State of California without permission of the
Court.
(b) A place not within the State of California if permission of the Court is
first obtained.
NNNNNNNNNHHI—ll—li—DHp—Iu—IHH
“\IQMAWNHooooflom-tflo
ATTACHMENT 3i
Document Filed Date
April 04, 2017
Case Filing Date
January 11, 2017
Category
Conservatorship of Person & Estate
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Preview
’1 JAN 1 I ZUI7 I GC-350 ATTORNEY OR PARTY WITHOUT ATTORNEY (name, address, and State Bar number): After recording return to: BUTTE COUNTY COUNSEL-SPECIAL COUNSEL TAHJ GOMES, Esq. SBN 205254 PO. BOX 1649 Oroville, CA 95965 TEL N0.: (530) 387-5150 FAX NO. (oplional): (530) 538-7722 ADDRESS (optional): E—MAIL BUTTE COUNTY PUBLIC ATTORNEY FOR (name): GUARDIAN BUTTE COUNTY SUPERIOR COURT OF CAUFORNIA. COUNTY OF STREET ADDRESS:1775 Concord Avenue 1775 Concord Avenue MAILING ADDRESS: N Chico, CA CITY AND ZIP CODE: 95928 BRANCH NAME: Probate Department FOR RECORDER‘S USE ONLY CONSERVATORSHIP OF (name): CASE NUMBER: KIRKLAND PEIRSON CONSERVATEE 17PRGOG4Q FOR COURT USE ONLY LETTERS OF CONSERVATORSHIP [El Person El Estate El Limited Conservatorship ‘ Superior oUunur udlllOfnla 1. E (Name): E BUTTE COUNTY PUBLIC GUARDIAN conservator of (name): D KIRKLAND limitedconservator PEIRSON of the EIperson is the appointed Elestate I I. Cmmtvof Butte .~ ml"~—-T APR 04 2. D (For conservatorship that was on December 31, 1980, a guardianship of an adult or of E 2017 the person of a mam’ed minor) (Name): was appointed the guardian of the D person CI estate by order dated D KI I ner,ClerI\ D By, (specify): and is now the conservator of the D person Depul' CI estate of (name): 3. E Other powers have been granted or conditions imposed as follows: a. E] Exclusive authority to give consent for and to require the conservatee to receive medical treatment that the conservator in good faith based on medical advice determines to be necessary even if the conservatee objects. subject to the limitations stated in Probate Code section 2356. (1) C] This treatment shall be performed by an accredited practitioner of the religion whose tenets and practices call for reliance on prayer alone for healing of which the conservatee was an adherent prior to the establishment of the conservatorship. (2) D (If court order limits duration) This medical authority terminates on (date): b. D Authority to place the conservatee in a care or nursing facility described in Probate Code section 2356.5(b). c. CI Authority to authorize the administration of medications appropriate for the care and treatment of dementia described in Probate Code section 2356.5(c). d. C] Powers to be exercised independently under Probate Code section 2590 are specified in Attachment 3d (specify powers, and limitations). restrictions, conditions, e. D Conditions relating to the care and custody of property under Probate Code section 2402 are specified in Attachment 3e. f. D Conditions relating to the care, treatment, education, are specified in Attachment 3f. and welfare of the conservatee under Probate Code section 2358 9. a (For limited conservatorship only) Powers of the limited conservator of the person underProbate Code section 2351.5 are specified in Attachment 39. h. D (For limited conservatorship only) Powers of the limited conservator of the estate under Probate Code section specIf ed in Attachment 3h. 1830(b) are 4. D The conservator Isnot authorized to take possession of money or any other property without specific court order. a 5. Number of pages attached: 1 WlTl:lER§Rckifk‘ff£t1 ’ourt, with seal of the court affixed. ER .Deputy Page1of 2 nservatorshlp of the estate as provlded ln Probate Code §1875. § 1834 Probate Code. Fun-n Ado ted tor Mandatory Use LETTERS OF CONSERVATORSHIP 90-;2893 Code of Clvll Procedurzea. § 2015 6 Martin Dean's Judicia Council of California GC-350 (Rev. July 1. 2015] m (Probate-Guardianships and Conservatorships) www.courts.ca.gov ESSENTIAl FflRMS BUTTE COUNTY PUBLIC GUARDIAN GC-350 CONSERVATORSHIP OF (name): CASE NUMBER: KIRKLAND PEIRSON _ CONSERVATEE NOTICE TO INSTITUTIONS AND FINANCIAL INSTITUTIONS (Probate Code sections 2890-2893) When these Letters of Conservatorship (Letters) are delivered to you as an employee or other representative of an institution or financial institUtion (described below) in order for the conservator of the estate (1) to take possession or control of an asset of the conservatee named above held by your institution (including changing title, withdrawing all or any portion of the asset, or transferring all or any portion of the asset) or (2) to open or change the name of an account or a safe-deposit box in your financial institution to reflect the conservatorship, you must fill out Judicial Council form 60-050 (for an institution) or form 60-051(for a financial institution). An officer authorized by your institution or financial institution must date and sign the form, and you must file the completed form with the court. There is no filing fee for filing the form. You may either arrange for personal delivery of the form or mail it to the court for filing at the address given for the court on page 1 of these Letters. The conservator should deliver a blank copy of the appropriate form to you with these Letters, but it is your institution's or financial institution’s responsibility to complete the correct form, have an authorized officer sign it, and file the completed form with the court. If the correct form is not delivered with these Letters or is unavailable for any other reason, blank copies of the forms may be obtained from the court. The forms may also be accessed from the judicial branch' s public Web site free of charge. The Internet address (URL) is w. courts. ca. gov/fonns/. Select the form group Probate—Guardianships and Conservatorships and scroll down to form GC- 050 for an institution or form 60- 051for a financial institution. The forms may be printed out as blank forms and filled In by typewriter or may be filled out online and printed out ready for signature and filing. An institution under California Probate Code section 2890(0) is an insurance company, agent, or broker; an investment company; an investment bank; a securities broker-dealer; an investment advisor; a financial planner; a financial advisor; or any other person who takes, holds Institutions must file a or controls an asset subject to a conservatorship or guardianship other than a financial institution. Notice of Taking Possession or Control of an Asset of Minor or Conservatee (form GC--050) for an asset ofthe conservatee held by the institution. institution. A single form may be filed for all affected assets held by the A financial institution under California Probate Code section 2892(b) Is a bank. a trust, a savings and loan association, a savings bank, an industrial bank, or a credit union. Financial institutions must file a Notice of Opening or Changing a Guardianship or Conservatorship W} Account or Safe-Deposit Box (form GC- 051) for an account or a safe-deposit box held by the financial institution. A single form may be filed for all affected accounts or safe-deposit boxes held by the financial institution. LE'I'I'ERS OF CONSERVATORSHIP AFFIRMATION lsolemnly affirm that I will perform according to law the duties of IE] conservator D limited conservator. Executed on (date): xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx ,at (place):Refer to Probate Code Section 2922(b) (TYPE0R PRINT NAME) (SIGNATUREor APPOINTEE) CERTIFICATION Icertify that this document,including any attachments, is a correct copy of the original on file in my office, and that the Letters issued to the person appointed above have notbeen revoked, annulled, or set aside, and are still in full force and effect. (SEAL) Date: Clerk, by ,Deputy Gcsso LETTERS 0F CONSERVATORSHIP PageZof2 [Rev. July 1. 2015] Marlin Dean‘s (Probate-Guardianships and Conservatorships) ESSENTIAL FIIRMSj“ . BUTTE COUNTY PUBLIC GUARDIAN ATTACHMENT 3i 1. Conservator has authorization for the care, custody and control of, and for charge of the education of the Conservatee pursuant to Probate Code \OOOVQM-wu—a §2351 (a). 2. Pursuant to Probate Code §2352, Conservator has the authority to fix the residence of the Conservatee at: (a) Any place within the State of California without permission of the Court. (b) A place not within the State of California if permission of the Court is first obtained. NNNNNNNNNHHI—ll—li—DHp—Iu—IHH “\IQMAWNHooooflom-tflo ATTACHMENT 3i