Metaverse Justice Group - Conservatorship Intake - Questionnaire

Welcome To The Metaverse Justice Group Conservatorship Intake

Thank you for placing your trust in our firm during this important time. We understand that navigating the conservatorship process can feel overwhelming, and our team is here to help make the process as clear and manageable as possible.
Please complete this secure intake form so we can gather the information needed to assist you. The form should take approximately 15–20 minutes to complete. You may save your progress and return at any time.
After submission, our team will review your information and follow up with the next steps or any additional information that may be needed.
Let’s begin with your information below.

Petitioner's Personal and Family Data

First Name *

Middle Name

Last Name *

Email *

Password *

Cell Telephone *

Full Address *

Relationship to proposed conservatee *

If petitioner is the proposed conservatee's spouse, is petitioner a party to legal separation, dissolution, or annulment, or adjudication of nullity of marriage proceeding? *

Yes No

If petitioner is the proposed conservatee's domestic partner, has petitioner terminated the domestic partnership or does petitioner intend to do so? *

Yes No

If petitioner is the proposed conservatee's domestic partner, is petitioner a party to legal separation, dissolution, or annulment, or adjudication of nullity of marriage proceeding? *

Yes No

Is petitioner a creditor? (Does the proposed conservatee owe petitioner money?) *

Yes No

Proposed Conservatee's Personal and Family Data

Name (and all variations used): *

Date Of Birth *

Social Security Number *

Address during the past 5 years *

Permanent address if different from that given above:

Is the conservatorship for the Person, Estate, or Both?

Can the proposed conservatee continue to live at their current residence? *

Yes No

Is the proposed conservatee currently a patient in, or on leave of absence from, a California state institution?

Yes No

Is the proposed conservatee receiving benefits from the Department of Veterans Affairs (VA)?

Yes No

Does the proposed conservatee have a developmental disability?

Yes No

Is the proposed conservatee able to complete an affidavit of voter registration? *

Yes No

Are they able to attend the hearing? *

Yes No

Information Required to Identify Persons Entitled to Notice and to Give Notice of Hearing

Name of proposed conservatee's spouse or domestic partner

Address of proposed conservatee's spouse or domestic partner

Names, addresses, and relationships of relatives within second degree (children, parents, grandchildren, grandparents, brothers, sisters):

Names

Relationship

Address

Does the conservatee have a spouse or registered domestic partner?

✓

Yes

✓

No

Name of Conservatee’s Spouse or Registered Domestic Partner

Children of predeceased spouse of proposed conservatee:

Conservatee’s spouse or registered domestic partner Phone Number

Conservatee’s spouse or registered domestic partner Address

Siblings of proposed conservatee's parents, and if none, children of proposed conservatee's parents' siblings:

Children of proposed conservatee's siblings:

What were the efforts made to find the proposed Conservatee’s relatives?

Relatives within the first degree (adult children and parents);

Relatives within the second degree (grandparents, adult grandchildren, sisters, and brothers);

Relatives pursuant to Probate Code §1821(b) if there are no spouse or domestic partner of proposed Conservatee or relatives within the second degree known to Petitioner;

Names and telephone numbers (home, work, cell) of neighbors who are familiar with the proposed Conservatee’s situation; and

Names and telephone numbers (home, work, cell) of friends who may be able to assist the Court Investigator in understanding the proposed Conservatee’s situation.

Information for the Confidential Supplemental Information Form

Does the proposed Conservatee accept informal or formal assistance voluntarily?

Yes No

Did the proposed Conservatee ever execute a limited, general, or durable power of attorney for health care and/or estate management?

Yes No

What health services were provided to the proposed Conservatee during the past 12 months? If so, describe.

Were any social services provided in the past 12 months? If so, describe.

Any estate management assistance rendered in the past 12 months? If so, describe.

What diagnosis has the proposed Conservatee’s physicians given for their present disability? How long have they been disabled?

What are specific examples from the proposed Conservatee’s daily life showing significant behavior patterns indicating that they are unable to provide properly for their needs for physical health, food, clothing, and shelter?

Can the proposed Conservatee bathe, groom, and dress without assistance?

What is their physical condition? Are they bedridden or in a wheelchair? Can they walk unassisted?

Do they cook for themselves? Shop for food and clothing by themselves?

Have there been recent medical crises? Have they fallen recently or been hospitalized?

What is the proposed Conservatee’s mental condition?

Are they forgetful? If yes, describe the consequences of the forgetfulness.

Are they delusional or suffering from hallucinations? If yes, describe the consequences of these problems.

Do they recognize familiar people, places, and things?

Are they alert and oriented to person, place, and time?

Do they recognize their physical needs? Can they communicate these needs to others who can meet those needs?

If the proposed Conservatee lives at home, what is the condition of the residence? Are there trip-and-fall hazards? Do the appliances work?

Do other people live with the proposed Conservatee? If so, do they help or take advantage of them?

What are specific examples from the proposed Conservatee’s daily life showing significant behavior patterns that indicate that they are unable to manage their financial resources or to resist fraud or undue influence?

Does the proposed Conservatee pay their own bills? Have they received notice of nonpayment of utilities? Do they bounce checks? Forget to pay bills?

Have they made imprudent gifts or purchases?

Are they easily influenced by others? If so, give examples.

What are the circumstances that require the issuance of a temporary conservatorship of the person (if applicable)?

Who will serve a Notice of Hearing (temporary conservatorship) and Citation (general conservatorship) with the Petition(s) on the proposed Conservatee (name, address, and telephone number)?

Capacity Declaration Information

Physicians' names, addresses, and telephone numbers:

Are dementia powers requested?

Yes No

Value of Conservator’s Estate

Character and estimated value of property of the conservatorship estate (for Petition and for purposes of calculating amount of the conservatorship bond):

The estimated value of the proposed Conservatee’s personal property:

Their probable annual gross income from:

Real property:

Personal property:

Pensions, if any:

Wages, if any:

Public assistance benefits:

Social Security payments:

Estimated value of any real property:

Documents and Other Information

Bank and savings and loan association accounts, name and address of institution or branch:

Real property (bring deeds if available, otherwise addresses):

Securities (a copy of a statement from each brokerage account):

Pension and retirement plans:

Tangible personal property, e.g., jewelry, paintings, cars, household furniture:

Insurance policies, e.g., life, health, disability, auto:

Business interests (partnership agreements, shareholder agreements, bylaws, etc.):

Property located outside California (deeds if available, otherwise addresses):

Other property, e.g., royalties, mineral interests, accounts or notes receivable:

Jointly held property and Totten trusts. Give special attention to how it will be managed and whether it should be used first or last in supporting the conservatee:

Trusts of which proposed conservatee is beneficiary:

Additional assets:

Safe-deposit boxes. Give name and address of institution and box number; also, location of safe-deposit keys and name and address of any other person having access; describe contents:

Name, address, and description of claim by others to property held by proposed conservatee. Is claim admitted?

Description of claim by proposed conservatee to property held by another, including name and address of third party, description of property, and nature of claim:

Is proposed conservatee a party to any contracts? Name and address of other parties to contract, nature of contract, and copy, if available:

Debts. Names and addresses of creditors, amount of indebtedness, nature of debts, and whether liability is admitted or disputed:

What are proposed conservatee's testamentary plans? Names and addresses of persons who assisted in planning:

Has proposed conservatee made a will? Is a copy available? If so, from whom? Who are the beneficiaries?

Yes No

Is proposed conservatee the settlor or trustee of any trust?

Yes No

Does proposed conservatee have an attorney?

Yes No

Proposed Conservator's Personal Data

Did the proposed Conservatee ever express a preference concerning the appointment of a Conservator? Obtain a copy of any written nomination.

Name (how does the proposed conservator sign legal documents?):

Address:

Home phone number:

Work phone number:

Mobile phone number:

Date of birth:

Social Security number:

Driver's license state and number:

How long has the proposed Conservator known the proposed Conservatee (years and months)?

Whether the proposed conservator is the proposed conservatee's spouse, and whether any divorce, dissolution, or marital separation proceedings have been commenced:

Is the proposed Conservator a professional fiduciary? If so, we will need their license number and the date the license was last renewed.

If a professional fiduciary is the Petitioner, who engaged them?

What were the circumstances and manner of their engagement?

Before their engagement, what was the prior relationship between the professional fiduciary and the proposed Conservatee, their family, or their friends?

Proposed Conservator's Relation to Proposed Conservatee

Is the proposed conservator also the petitioner in the conservatorship proceeding?

Was the proposed conservator nominated, and if so, by whom?

Proposed Conservator's Fitness to Act

Has proposed conservator filed for bankruptcy?

Has proposed conservator committed any crimes in the past, of any degree?

Are there powers under Probate Code section 2590 that the proposed Conservator would like to request? (See attachment)

Will the proposed Conservatee be adjudged to lack the capacity to give informed consent for medical treatment?

Will special orders regarding dementia powers be requested?

Submission Screen

You’re almost done. When you submit, our team will review your information, resolve any gaps, and prepare your documents. You’ll have a chance to ask questions and confirm details before anything is finalized.

If you would like to review your responses, you can select each screen and review your answer or select the preview button which will open a print screen page. Click the “Submit” button below to be directed to a page where you will be able to pay for your chosen plan. After payment is received, your information will be securely sent to our office for preparation of your documents.

Your Progress