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  • FRANCES M. BALKOVICH 2005 REVOCABLE TRUST DTD 01/26/2005Trust document preview
  • FRANCES M. BALKOVICH 2005 REVOCABLE TRUST DTD 01/26/2005Trust document preview
  • FRANCES M. BALKOVICH 2005 REVOCABLE TRUST DTD 01/26/2005Trust document preview
  • FRANCES M. BALKOVICH 2005 REVOCABLE TRUST DTD 01/26/2005Trust document preview
  • FRANCES M. BALKOVICH 2005 REVOCABLE TRUST DTD 01/26/2005Trust document preview
  • FRANCES M. BALKOVICH 2005 REVOCABLE TRUST DTD 01/26/2005Trust document preview
  • FRANCES M. BALKOVICH 2005 REVOCABLE TRUST DTD 01/26/2005Trust document preview
  • FRANCES M. BALKOVICH 2005 REVOCABLE TRUST DTD 01/26/2005Trust document preview
						
                                

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1 MICHAELJ. VALENCIA,ESQUIRE, SB¹78432 JESSICA ROWEN, ESQUIRE, SB¹301289 2 ROSS, HACKETT, DOWLING, VALENCIA& WALTI A Professional Corporation 3 600 El Camino Real Post Office Box 279 ap,g I< ~WO COU~ 4 San Bruno, California 94066-0279 Telephone: (650) 588-0367 SEP 1 9 2016 r Attorneys for Petitioners 6 LINDAMOLINARI& JOHN TULICH er QMsiiPi Pf C: IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF SAN MATEO 10 In Re: ) CASE NO. ) FRANCES M. BALKOVICH2005 ) EX PARTE T R 12 REVOCABLE TRUST DATED ) CONFIRMING ASSET TO TRUST JANUARY 26, 2005, AS AMENDED ) (Probate Code $$ 850i a)(3) & 17200.1) 13 AND RESTATED. ) ) 14 15 1. Petitioners LINDAMOLINARIand JOHN TULICH, are the duly appointed and acting 16 Successor Co-Trustees of the FRANCES M. BALKOVICH2005 REVOCABLE TRUST, DATED 17 JANUARY 26, 2005, AS AMENDED AND RESTATED ("Trust" ), pursuant to Paragraph 3 of the 18 FIRST AMENDMENTTO THE FRANCES M. BALKOVICHREVOCABLE TRUST DATED 19 JANUARY 26, 2005, AS RESTATED ON JANUARY 19, 2006 ("First Amendment" ). A true and 20 correct copy of the Trust is attached hereto as Exhibit A and is incorporated herein by this reference. 21 A copy of the First Amendment is attached hereto as Exhibit B and incorporated herein by this 22 reference. 23 2. Venue is proper in San Mateo County as Petitioner JOHN TULICH is a resident of San'4 CD CV f Mateo County and the principal place of trust administration is located in San Mateo County, ID o CD 0) 25 California. CQ o CL 26 3. The Trust was created by FRANCES M. BALKOVICH as Settlor. FRANCES M. CJ CO CV Cll CD CI\ Ql 27 BALKOVICHdied in San Mateo County on April 2, 2016. A copy of her death certificate is Ku or CI N r 28 ID IL r In Re: FRANCES i%I. BALKOVICH2005 REVOCABLE TRUST, AS AMENDED & RESTATED Petition for Order Confirming Asset to Trust 1 attached hereto as Exhibit C and is incorporated herein by this reference. Petitioners have 2 commenced administration of the Trust upon the death of FRANCES M. BALKOVICH. 4. The purpose of this Petition is to obtain an Order from this Court under Probate Code 4 Section 17200.1, declaring that the interest of FRANCES M. BALKOVICH in the property 5 identified below is actually owned by the Trust, and is part of the Trust estate. 6 5. The asset in question is the death benefit proceeds of Delaware Life Policy Number 7 0008114750 on FRANCES M. BALKOVICH,the Insured. 6. Petitioners believe and allege that FRANCES M. BALKOVICHinadvertently failed to 9 transfer the asset set forth above to the ownership of the Trust. 10 7. It is particularly apparent that FRANCES M. BALKOVICH intended that the 11 aforementioned asset was to be owned by the Trust as she executed a pour-over Will dated January 12 19, 2006. A copy of the Last Will& Testament of FRANCES M. BALKOVICH ("Will") is attached 13 hereto as Exhibit D and is incorporated herein by this reference. Article Five on page 2 of the Will 14 declares that the residue of the estate passes to the Trustees then in office of the FRANCES M. 15 BALKOVICH2005 REVOCABLE TRUST DATED JANUARY 26, 2005, AS AMENDED AND 16 RESTATED. 17 8. Pursuant to the California Uniform Testamentary Additions to Trust Act, Probate Code 18 Section 6300, the property described herein becomes a part of the Trust to which it is given and shall 19 be administered and disposed of in accordance with the terms of the Trust. It is therefore clear that 20 such assets should be confirmed as Trust property that is subject to the administration of and 21 disposition in accordance with the Trust's terms. 22 9. Based on the foregoing, Petitioners respectfully request this Court confirm the asset 23 described herein as an asset ofthe Trust to be held and administered pursuant to the terms of thereof. 24 10. The names and addresses of the beneficiaries of the Trust and heirs of FRANCES M. 25 BALKOVICH,all of whom are entitled to notice are as follows: 26 Michael Tulich 2039 Mezes Ave. 27 Belmont, California 94002 28 In Re: FRANCES M. BALKOVICH2005 REVOCABLE TRUST, AS AMENDED & RESTATED Petition for Order Confirming Assetto Trust John Tulich 508 Compass Dr. Redwood City, California 94065 Linda Molinari 192 McNear Drive San Rafeal, California 94901 Kate Vinal 3404 Glendora Dr. San Mateo, California 94403 Matthew Callicotte 940 W. Angus Ave. San Bruno, California 94066 Michael Callicotte 10 1835A Green Street San Francisco, California 94123 11. No one has requested Special Notice of this proceeding. 12 12. Allpersons entitled to notice of hearing have waived this right and consent to the relief 13 sought herein. The waivers of notice and consent to petition are attached hereto as Exhibit E, 14 collectively, and are incorporated herein by this reference. 15 WHEREFORE, Petitioners pray for: 16 1. An Order confirming that all rights. title, and interest in and to the proceeds of Delaware Life 17 Insurance Policy Number 0008114750 for the Insured, FRANCES M. BALKOVICHis an 18 asset ofthe FRANCES M. BALKOVICH2005 REVOCABLE TRUST DATED JANUARY 19 26, 2005, AS AMENDED AND RESTATED, to be held, administered, and distributed by 20 Petitioners as Successor Co-Trustees pursuant to the terms thereof; and 21 2. Any such further orders as the Court deems proper. 22 Dated: September T, 20 1 6 ROSS, VAL HACKETT, DOWLING, N LTI 24 A Pro on 1 Corpora 'on 25 L M I 26 a o en ttorneys For P i ioners 27 28 In Re: FRANCES M. BALKOVICH2005 REVOCABLE TRUST, AS AiVIENDED8c RESTATED Petition for Order Confirming Asset to Trust VERIFICATION I, LINDAMOLINARI,a Petitioner herein, declare: I have read the foregoing EX PARTE PETITION FOR ORDER CONFIRMING ASSET TO TRUST and know its contents. It is true to the best of my knowledge, except as to the matters which are stated on information and belief, and as to those matters I believe them to be true 7 We declare under penalty of perjury under the laws of the State of California that the 8 9 foregoin g is true and correct and that this Verification was executed on the lIST day of ,2016 at San Bruno, Calrfoani . 10 LINPA MOLINA@ 18 20 21 22 23 24 25 26 27 28 In Re: FRANCES M. BALKOVICH2005 REVOCABLE TRUST, AS AMENDED & RESTATED Petition for Order Confirming Assetto Trust VERIFICATION I, JOHN TULICH, a Petitioner herein, declare: I have read the foregoing EX PARTE PETITION FOR ORDER CONFIRMING ASSET TO 4 TRUST and know its contents. 5 It is true to the best of my knowledge, except as to the matters which are stated on 6 information and belief, and as to those matters I believe them to be true. We declare under penalty of perjury under the laws of the State of California that the 8 the,Panni 600 El Cnmina Renl, P.O. Box 179 Snn Bruno, CA 94066 (650) 508-0367 Telephone: Fncsimrlcr (650)588-3413 apportionment and allocation of receipts and expenses between these accounts shall be governed by the provisions of the California Revised Uniform Principal and income Act from time to time existing. The Trustee, at the Trustee's discretion, shall determine any matter not provided for either in this instrument or in the California Revised Uniform Principal and income Act. 11. Other property acceptable to the Trustee maybe added to This Trustbyany person, by the Will or Codicil of the Settlor, by the proceeds of any life insurance, or otherwise. 12. The Settlor may at any time amend any terms of this Trust by written instrument signed by the Settlor. No amendment shall substantially increase the Trustee's duties or liabilities or change the Trustee's compensation without the Trustee's consent, nor shall the Trustee be obligated to act under such an amendment unless the Trustee accepts it. If a Trustee is removed as a result of refusal to accept an amendment, the Settlor shall pay to the Trustee any sums due and shall indemnify the Trustee against liability the Trustee has lawfully incurred in administering the Trust. 13. The Settlor may at any time revoke this instrument in whole or in part by a written instrument. lfthe Settlor revokes this instrument, the Trustee shall deliver promptly to the Settlor or her designee all or the designated portion of the trust assets. ff the Settlor revokes this instrument entirely or with respect to a major portion of the assets subject to the instrument, the Trustee shall be entitled to retain sufficient assets reasonably to secure payment of liabilities the Trustee has lawfully incurred in administering the Trust, including Trustee's fees that have been earned, unless the Settlor shall indemnify the Trustee against loss or expense. 14. Any Successor Trustee shall be entitled to reasonable compensation from —— — — BACKETI;DOWLING> ROSS, VALE(eCIA 4 WALTI Corpore cion A Professional 600 El Cnnsino Renl, P.O. Boa 379 San Ilrnno, CA 94066 (650) 588-0367 Telephone; Facsimile: (650) 588-3413 time to time without prior court order. 15. ln any event, the Trustee shall be entitled to be reimbursed for any expenses of the Trust that they have paid. 16. ln the event any beneficiary under this Trust shall singly or in conjunction with any other person or persons; contest in any court the validity of this Trust or of the deceased Settlor's last Will or shall seek to obtain an injunction in any proceeding in any court that this Trust or any of its provisions or that such Will or any of its provisions is void, or seek otherwise to void, nullify, or set aside this Trust or any of its provisions, then the right of that person to take any interest given to him or her by this Trust shall be determined as it would have been determined had the person predeceased the execution of this Declaration of Trust without surviving issue. 17. The Trustee is hereby authorized to defend, at the expense of the Trust Estate, any contest or other attack of any nature on this Trust or any of its provisions. 18. Resignation of Trustee: Any Trustee hereunder may resign at any time by giving written notice of such intention to resign to the Trustor, ff competent; otherwise to her duly appointed conservator or guardian, if any. 19. No Court Proceeding Necessary; The appointment and qualification of the Successor Trustee provided for in Article 6 shall be effective without any court approval or decree. Such Successor Trustee shall indicate acceptance of the Trust by signing the original of this Agreement. 20. Expenditures of Funds During incapacity: White the original Trustee remains incapacitated, the Successor Trustee shall pay unto or expend for the benefit of Trustor ROSS, BACKE7T, DOWLING,- VALENCLX6r WALTI A Pro(essionsl Corpore(isn 600 El Cumin o Real, P.O. Box 379 Ssn Bruno, CA 94066 (650) 580-0367 Telephone; Facsimile: (650)588-34l3 such sums of the net income and principal of the Trust Estate, as the Successor Trustee shall deem necessary or advisable for the health, care, comfort, support, maintenance, general welfare and reasonable enjoyment of Trustor in accordance with the standard of living to which she is accustomed at the time of the execution of this Trust instrument, taking into consideration, however, such other resources as, in the Successor Trustee's knowledge, are available to or for the use or benefit of Trustor. The Trustee is expressly authorized to arrange for convalescent care, extended care and nursing care for Trustor, if the Successor Trustee deems such type of care is necessary or advisable. ln providing nursing home or permanent care, Successor Trustee shall require that any establishment, agency, or facility providing such care provide reasonable comfort and maintenance for Trustor at the standard of living that had been maintained by or for Trustor up to the time of admission, medical and nursing care of adequate quality which covers all conditions of physical and mental infirmities attendant upon old age, and the best care and comfort in all situations relating to health, medical, dental, hospital and nursing home expenses, and expenses of invalidism, as Trustor would have provided for herself in the absence of this Trust, if not incapacitated. The Successor Trustee shall not take into consideration the interest of remaindermen in expending monies for the benefit of Trustor. 21. The Trust as restated in this instrument may be referred to as the FRANCES Ence M. BALKOVICH2005 REVOCABLE TRUST DATED JANUARY 26, 2005. ROSS, HACKE IT, I)OWLING, VALENCIA& WALTI A Proicesioncl Corpore non 600 El Cnmino Reel, P.O. Boe 179 Son Bruno, CA 94066 (650) 588-0367 Telephone: mile: (650) 566-34 l3 > Executed at San Bruno, California, on the 19'" day of January, 2006. J FRANCES BALKOVICH IB(1. Settlor FRANCES M. BALKOVlCH Trustee ROSS,HACKETTrDOWLING,— —— VALENCIAh WALTI A Professional Corporation 600 El Comino Real,PAL Box 379 San Bruno, CA 94066 (650) 5$ $ -0367 Telephone: Facsim0c: (650)5$ $ -3413 10 Icertify that Ihave read the foregoing Restatement of Revocable Trust and that it correctly states the terms and conditions under which the Trust Estate is to be held, managed, and disposed ofby the Trustee. Iapprove said Restatement of Revocable Trust in all particulars and request that the Settlor execute it. DATED: January / 7, 2006 FRANCES M. BALKOVICH Settlor Icertify that I have read the foregoing Restatement of Declaration of Trust and that it states the terms and conditions under which the Trust Estate is to be held, managed, and disposed of by me, the Trustee; that I agree to act as Trustee pursuant to the provisions of the said Trust. p7 r~~M FRANCES M. BALKOVICH Trustee ROSS~HACKEITs DOWLINGs VALKPICIAss WALTI Corpornlion A Professionel 600 El Cemino Real, P.O. Boe 279 Sen Bruno, CA 94066 Telephone: (658) 588-0367 Fnesimiles (650)5RR-34t3 11 STATE OF CALIFORNIA ) ) ss. County of San Mateo ) On January lW, 2006, before me, ~yW'1 R. Zs t r=~a a Notary Public in and for said County and State, personally appeared FRANCES M. BALKOVICHproved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this instrument, and acknowledged to me that she executed the same in her authorized capacity, and that by her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. ~/ Notary Public I.(~C~~iO ~~ N(MI R.DfvfRP I '-A Comm. 4 1395273 I NOTARy PUBLIC-CALIFORNIA San Aiatso County IAy Comm. Rap(res J00.2I,2007 ROSS, HACICEIT, DOWLINC, vALEiVCIA40 WALTI A Professional Corporation 600 El Csmina Real, P.O. Bos 379 Ssn Bruno, CA 94066 (650) 588-0367 Telephone: (650)5SS-3413 Psesirailet 12 On the date written below, FRANCES M. BALKOVICH declared to us, the undersigned, that this instrument, consisting of fourteen (14) pages, including the page signed by us as witnesses, was the RESTATEMENT OF THE FRANCES M. BALKOVlCH 2005 REVOCABLE TRUST DATED JANUARY 26, 2005, and requested us to act as witnesses to it.She thereupon signed this Revocable Trust in our presence, all of us being present at the same time. We now, at her request, in her presence, and in the presence of each other, subscribe our names as witnesses. Executed on the 19'" day of January, 2006, at San Bruno, California. We declare under penalty of perjury that the foregoing is true and correct, f/+4~CD P/'~ ,CA 66bt'fi Residing at ~.~g 7i 35 z~~~~~i 4 +~ ,CA ROSS,HACKBTI, DOWLINC, VALENCIASr WALTI Corporation A Professional 600 Et Camino Real, P.O. Boa 279 San Bmtno, CA 94066 (650) 588-0367 Telephone: (650)588-3413 Fnesimae: 13 SCHEDULE "A" THE RESTATED FRANCES M. BALKOVICH2005 REVOCABLE TRUST DATED JANUARY 26, 2005 Assets Transferred to Trust 1. Morgan Stantey Brokerage Account ¹ 101-075676-061. Dated: January 16, 2006 g7 FRANCES M. BALKOV(CH ROSSrRAC(CKSX,3) OWLING» VALENCIAe% WALTl A Professional Corporation 600 Kl Cnmino Rest, P.O. Boz 379 San Bruno, CA 94066 Tdephone: (658) SSS-0367 FaestmSet '(650)580-34i3 EXHIBIT B FIRST AMENDMENTTO THE FRANCES M. BALKOVICH REVOCABLE TRUST DATED JANUARY 26, 2005, AS RESTATED ON JANUARY 19, 2006 FRANCES M. BALKOVICH, Settlor and Trustee of the FRANCES M. BALKOVICH2005 REVOCABLE TRUST DATED JANUARY 26, 2005, AS RESTATED ON JANUARY 19, 2006, pursuant to ARTICLE 12, of said Trust, does hereby amend said Trust by deleting in its entirety, ARTICLE 3, ARTICLE 5 AND ARTICLE 6 of the FRANCES M. BALKOVICH 2005 REVOCABLE TRUST, AS RESTATED ON JANUARY 19„2006, and replacing said ARTICLE 3, ARTICLE 5 and ARTICLE 6 as follows: 3. If at any time, as certified in writing by two licensed physicians not related by blood or marriage to the Settlor or to any beneficiary of this Trust, the Settlor has become physically or mentally incapacitated, whether or not a court of competent jurisdiction has declared her incompetent or mentally ill orhas appointed a conservator, the Trustee shall apply for the Settlor's benefit the amounts of net income and principal necessary in the Trustee's discretion or desirable for the Settlor's health, support, comfort, enjoyment and welfare, until either the Trustee's determination or the certification in writing by two licensed physicians not related by blood or marriage to the Settlor or to any beneficiary of this Trust, that the incapacity has been removed and the BOSS, HACKE'FF, DOWLI1VG, VALE 1V CIA Bc WALTI Corporation A FroPeeeional 600 El Camino Real, PA). Box STQ San Brnno, CA 04066 (6$ 0) $ 88.066'P Telephone: Facsimile> (6$ 0)$ 88%416 1 Settlor is again able to manage her own affairs. Any income in excess of the amounts so applied for the Settlor's benefit shall be added to principal. If the Settlor/Trustee is determined to be incapacitated as herein provided, then the first Successor Co- Trustees, namely, LINDA MOI INARI and AGNES BELLUOMINI shall serve as Co- Trustees during the incapacity of the Settlor/Trustee. In the event either that LINDA MOLINARI or AGNES BELLUOMINI is unable to serve as Co-Trustee, then JOHN TULICH shall serve as Alternate Co-Trustee in their stead. The Settlor desires to always have two(2) Trustees acting as Co-Trustees in her stead. 5. Upon the death of the Settlor, and after expenses have been paid, the Trust Estate of the Settlor shall be distributed as follows: 1. To my nephew, ED%/I/ARD BALKOVICH,the sum of Five Hundred Dollars ($ 500.00). Should he predecease Settlor, then this gift shall lapse. 2. The rest, residue and remainder of the trust estate shall be equally divided and distributed as follows: a. One-fifth of the trust estate to AGNES BELLUOMINI. Should AGNES BELLUOMINIpredecease me, then her share shall lapse; b. One-fifth of the trust estate to be equally distributed to the issue of my niece, KAREN CALLICOTTE, who has predeceased me; c. One-fifth of the trust estate to LINDA MOLINARI; One-fifth of the trust estate to JOHN TULICH; One-fifth of the trust estate to MICHAEL TULICH. ROSS, HACKETT, DOWLINQ, VALENCIA8s WALTI A Frofesslonal Corporation 800 El Camlno Real, P.O. Box %TO San Beano,CA 84066 (680) 588 Telephoner (650)58~41$ 088I'aeshnlle: 1 In the event any of the above named Beneficiaries with the exception of AGNES BELLUOMINI, shall predecease Trustor, such share shall pass to such Beneficiary's lawful surviving issue by right of representation, or in default thereof to the survivors among them in equal shares. In the event that any of the beneficiaries at the time of distribution have not yet attained the age of twenty-five (25) years, then and in such case the share of said beneficiary shall be held in trust by the surviving parent of such beneficiary as Custodian under the California Uniform Transfer to Minors Act until said child attains his or her twenty-fifth (25th) birthday. 6. The original Trustee of this Trust is FRANCES M. BALKOVICH. If for any reason FRANCES M. BALKOVICHis unable to serve as Trustee, then LINDA MOLINARI and AGNES BELLUOMINIshall serve as Successor Co-Trustees. If for any reason either IINDA MOLINARIor AGNES BELLUOMINIis unable to serve as Co- Trustee, then JOHN TULICH shall serve as Alternate Co-Trustee in their stead. In all other respects, the undersigned does hereby ratify and confirm the FRANCES M. BALKOVICH 2005 REVOCABLE TRUST DATED JANUARY 26, 2005, AS RESTATED. ROSS, HACKETT, BOWLING, VALENCIA de WAI/FI Corporation A Professional 600 El Camlao Reel, P.O. Boa S'IS Sso Brano, CA 94066 (660) d88&$ Telephonet (660)dSRWI419 6I'aeshndec IN WITNESS WHEREOF, I have hereunto set my hands and affixed my signatures at San Bruno, San Mateo Coun —, aliforgia his 19'" day of February, 2008. 2/- (~~. AE/W~arM<.'( FRANCES h/I. BALKOVICH, Settlor >rtixnrxz C.- J/. I.Q., I.~~A.PZ%+~aZ FRANCES M. BALKOVICH, Trustee WITNESSES: A"i~~<--... / I/ A P. ~ ~ ROSS, HACKE'FP, DOWLING, VALENCIA4r, %VALTI A Profeeeiooel CorporoSoo 600 El Camioo Real, P.O. Box %f0 Sao Rrano, CA 64066 (650) 5884)66@ Telephone< Fecelmlle: (6dO)58&$ 416 CERTIFICATION OF SETTLOR I certify that Ihave read the foregoing First Amendment to the FRANCES M. BALKOVICH 2005 REVOCABLE TRUST DATED JANUARY 26, 2005, AS RESTATED, and that it correctly states the terms and conditions under which the Trust Estate is to be held, managed, and disposed of by the Trustee. Iapprove the said FRANCES M. BALKOVICH 2005 REVOCABLE TRUST DATED JANUARY 26, 2005, AS RESTATED, in all particulars and request that the Trustees execute it. ( +~M~M ~'m / tMkw~M FRANCES M. BALKOVICH Settlor CERTIFICATION OF TRUSTEE I certify that Ihave read the foregoing First Amendment to the FRANCES M. BALKOVICH 2005 REVOCABLE TRUST DATED JANUARY 26, 2005, AS RESTATED and that it states the terms and conditions under which the Trust Estate is to be held, managed, and disposed of by me, the Trustee; that I agree to act as Trustee pursuant to the provisions of the said Trust, as Amended. j'WE! FRANCES M. BALKQVICH Trustee BO88, aaCBZVr, nOWLINC, VilLENCIkR %'~TI k Professional Corporation 600 El Camiao Beah P.O. Box %$ 9 eaa Braao, CA 94066 (660) dee&86T Telephoaei P~~~ (660)688~IS STATE OF CALIFORNIA ) ) ss. COUNTY OF SAN MATEO ) On this 19'" day of February, 2008, before me, Nini R. Devera, a Notary Public, personally appeared FRANCES M. BALKOVICH,who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within Instrument and acknowledged to me that she executed the same in her authorized capacity, and that by her signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct, WITNESS my hand and official seal. Ng@ry Public +o«<+ «n~ NIN< R. oEVERA jr Col)ill)f66fofl )P 'r<'g )4OtC)rfl Publfc <„~„'-'. } 7gst70() - Caffforrtf~ y Sctn Mateo Couttty Mv Colr5tt, pxgg~~ PSt) > 201 t ROSS, BACKETF< DOWLING, V<)LENCI5 & VViLLTr k Prolesslonsl Corporation 600 Rl Camlno Reap P.O. Box $ /0 8 o B~o, Ca64066 (650) 588-0667 Telephone: FacsimBe.(650)588%4')6 EXHIBIT C 0> httf 4 ' ' gaff L0I/IA "E.'0 VfrssiysILVI.J%l/e~ ffN2285IAE019/0/hfo'~r'A82III/tfLWIIIITK3'"f080«')I"3%%fffo%FLr/sian '; 9 1 Wl KOJ; 0 h ~ baal) (RbJ~ Fi &e '1~ OXaijm'a 8I 8yhII 81 W KBTii W Le e > pl ritES 8I J)~~%+i" ' ff'Jf fi "r " "Y~QXI>'Lvv/A~~PiVM~'joe'4""-'R'nf/JPPalTEt'4<-"'0' Hg rfvf'Q<~ '~JJASJT/2EIJ9ig*' COUNTY OF SAN MATEO HLEALTH SYSTEM .SAN MATEO:, TCALIFORNIA I FRANCES ., ,OIAEEEEEh»USER ruvsof otctclnt-pusr suev ; lflrncoal