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California Probate Code Section 2Legal Research Home > California Lawyer > Probate Code > California Probate Code Section 2
I am a duly sworn peace officer presently employed by
____________
______________________________, in the County of _____________,
in
the State of California.
3. On ________ (date) I personally interviewed ______________
(victim)
at _____ a.m./p.m. at ________________ (address). The victim
resides at ___________________ (address, telephone number, and
name
of facility, if applicable).
4. There is probable cause to believe that:
(a) ________________________________________________ (Victim)
is substantially unable to manage his or her financial
resources or to resist fraud or undue influence, and
(b) There exists a significant danger the victim will lose all
or
a portion of his or her property as a result of fraud or
misrepresentations or the mental incapacity of the victim, and
(c) There is probable cause to believe that a crime is being
committed against the victim, and
(d) The crime is connected to the victim's inability to manage
his or her financial resources or to resist fraud or undue
influence, and
(e) The victim suffers from that inability as a result of
deficits
in one or more of the following mental functions:
INSTRUCTIONS TO PEACE OFFICER: CHECK ALL BOXES THAT APPLY:
A( ALERTNESS AND ATTENTION
( 1. Levels of arousal. (Lethargic, responds only to
vigorous
and persistent stimulation, stupor.)
( 2. Orientation. Person ____ Time ____ (day, date, month,
season, year), Place ____ (address, town, state),
Situation ____ (why am I here?).
( 3. Ability to attend and concentrate. (Give detailed
answers
from memory, mental ability required to thread a
needle.)
B( INFORMATION PROCESSING
Ability to:
( 1. Remember, i.e., short- and long-term memory, immediate
recall. (Deficits reflected by: forgets question
before
answering, cannot recall names, relatives, past
presidents,
events of past 24 hours.)
( 2. Understand and communicate either verbally or otherwise.
(Deficits reflected by: inability to comprehend
questions,
follow instructions, use words correctly or name
objects;
nonsense words.)
( 3. Recognize familiar objects and persons. (Deficits
reflected
by: inability to recognize familiar faces, objects,
etc.)
( 4. Understand and appreciate quantities. (Perform simple
calculations.)
( 5. Reason using abstract concepts. (Grasp abstract aspects
of
his or her situation; interpret idiomatic expressions or
proverbs.)
( 6. Plan, organize, and carry out actions (assuming physical
ability) in one's own rational self-interest. (Break
complex tasks down into simple steps and carry them
out.)
( 7. Reason logically.
C( THOUGHT DISORDERS
( 1. Severely disorganized thinking. (Rambling, nonsensical,
incoherent, or nonlinear thinking.)
( 2. Hallucinations. (Auditory, visual, olfactory.)
( 3. Delusions. (Demonstrably false belief maintained
without or
against reason or evidence.)
( 4. Uncontrollable or intrusive thoughts. (Unwanted
compulsive
thoughts, compulsive behavior.)
D( ABILITY TO MODULATE MOOD AND AFFECT
Pervasive and persistent or recurrent emotional state which
appears severely inappropriate in degree to the patient's
circumstances.
Encircle the inappropriate mood(s):
Anger Euphoria Helplessness
Anxiety Depression Apathy
Fear Hopelessness Indifference
Panic Despair
5. The property at risk is identified as, but not limited to, the
following:
Bank account located at:________________________________________
(name, telephone number, and address
of the bank branch)
Account number(s):______________________________________________
Securities/other funds located at:______________________________
(name, telephone number,
and address of
financial institution)
Account number(s):______________________________________________
Real property located at:_______________________________________
(address)
Automobile described as: _______________________________________
(make, model/color)
_______________________________________
(license plate number and state)
Other property described as:____________________________________
Other property located at:______________________________________
6. A criminal investigation will ( will not ( be commenced
against ________________________________________________________
(name, address, and telephone number)
for alleged financial abuse.
BLOCKS 1, 2, AND 3 MUST BE CHECKED IN ORDER
FOR THIS DECLARATION TO BE VALID:
( 1. I am a peace officer in the county
identified above.
( 2. I have consulted concerning this case with a supervisor
in the county's adult protective services agency who
has signed below, indicating that he or she concurs
that, based on the information I provided to him
or her, or based on information he or she obtained
independently, this declaration is warranted under
the circumstances.
( 3. I have consulted concerning this case with an
individual qualified to perform a mental status
examination.
_______________________________________________________
Signature of Declarant Peace Officer
_______________________________________________________
Date
_______________________________________________________
Signature of Concurring Adult Protective
Services Supervisor
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Last modified: July 31, 2008 |