`
`DE-154
`TELEPHONE AND FAX NOS:
`FOR COURTUSE ONLY
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`(916) 650-6481
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`ATTORNEY OR PARTY WITHOUT ATTORNEY(Name,state bar number, and address):
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`DEPARTMENT OF HEALTH CARE SERVICES
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`ESTATE RECOVERY BRANCH
`FELED
`P.O. BOX 997425, MS 4720
`SACRAMENTO,CA 95899-7425
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`ATTORNEY FOR(Name): IN PRO PER/CREDITOR
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`SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO
`STREET ADDRESS: ATTENTION: PROBATE
`
`ovVorbratler—
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`MAILING ADDRESS:
`400 McALLISTER STREET, ROOM 103
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`_ CITYAND ZIP CODE:
`SAN FRANCISCO,CA 94102-4512
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`MATTER OF(Name):
`ROBERT SMALL
`
`
`Dx] _DECEDENT [] minor_[] trust, [] conservatee
`
`
`Superior Court of California
`County of San Francisco
`MAR 11 2024
`CLERK OF THE,COURT
`
`.
`
`Deputy Clerk
`
`
`
`;
`lama personinterestedin this proceeding.
`[DX]
`1. a.
`b. C] | am the attorney for a person interested in this proceeding (specify nameof interested person):
`
`
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`2. | REQUEST SPECIAL NOTICEof (complete onlyaorb):
`a. Xx the following matters (check applicable boxes):
`,
`(1)
`XxX] all the matters for which special notice may be requested. (Do not check boxes (2) — (8).)
`(2) CJ inventories and appraisals of property, including supplements
`(3) C] accountings by the personal representative
`(4) C] reports of the statusof administration
`(5) CJ objections to an appraisal
`(6) C] petitions for the sale of property
`(7) [] Spousal Property Petition (form DE-221) (Prob. Code, § 13650)
`(8) C] otherpetitions: [] all petitions L] the following petitions (specify):
`
`b.
`
`EF] the following matters (specify) «
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`3. SEND THE NOTICES to
`a.
`the interested person at the following address (specify): P.O. Box 997425, MS4720
`Sacramento, CA 95899-7425
`
`‘
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`b. C] the attorney at the following address (specify):
`
`a
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`Date: March 7, 2024
`
`>
`
`.RickyMahal, CollectionRepresentative==
`(TYPE OR PRINT NAME)
`C] Attorney for person requesting special notice (client’s name):
`Continued on reverse
`REQUEST FOR SPECIAL NOTICE
`(Probate)
`
`Form Approved bythe
`Judicial Council of California
`DE-154,GC-035 [Rev. January 1, 1998]
`Mandatory Use [1/4/2000]
`
`(SIGNATURE)
`
`Probate Code, §§ 1250
`2700( c), 17204
`
`

`

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`
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`| eAcENUMBER: PES-23-306725
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` z
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`NOTE: A formal proof of services or a written admission of service must accompanythis Request for Special Notice
`
`whenitis filed with the court.
`You must haveyour request served on either the personal representative, conservator, guardian, or trustee, or
`
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`his or‘herattorney, or obtain a signed Admissionof Service (see below).
`F CO
`PROOFOF SERVICE BY MAIL
`lam overthe agé-of18.andnot a party to this cause. | am a residentof or employedin the county where the mailing occurred.
`1.
`2. Myresidence or business addressis (specify): P.O. Box 997425, MS 4720
`Sacramento, CA 95899-7425
`| served the foregoing Request for Special Noticeon each person namedbelowbe enclosing a copy in an envelope addressed
`as shown below AND
`a C] depositing the sealed envelope with the United States Postal Service with the postagefully prepaid.
`b. Xx placing the envelopefor collection and mailing on the date and at the place shownin item 4 following our ordinary
`business practices.
`| am readily familiar with the business’practice for collecting and processing correspondence for mailing. On /
`the same day. that correspondenceis placed for collection and mailing, it is deposited in the ordinary course of business with the’
`United States Postal Services in a sealed envelope with postage fully prepaid.
`4. a. Date of deposit: March 7, 2024
`b. Place of deposit (city and state): Sacramento/CA
`| declare under penalty of perjury underthe lawsof the State of California that
`the foregoing is true and correct.
`.
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`MATTEROF(Name): ROBERT SMALL
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`
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`3.
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`Date: March 7, 2024
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`(SIGNATURE OF DECLARANT)
`(TYPE OR PRINT NAME)
`NAME AND ADDRESSOF EACH PERSON TO WHOM NOTICE WAS MAILED
`
`RAUL PAREDES-SERMENO, Personal Representative
`C/O Attorney NANCY ROSSI
`oe
`_ 1900 S. NORFOLKST., #350
`SAN MATEO,CA 94403
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`.
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`L] List of names and addresses continued in attachment.
`ADMISSION OF SERVICE
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`4. !amthe [1 personal representative, conservator, guardian, or trustee L] the attorney
`2.
`| ACKNOWLEDGE that I was served a copyof the foregoing Requestfor Special Notice.
`
`Date:
`
`(TYPE OR PRINT NAME)
`DE-184, GC-035[Rev. January 1, 1998]
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`
`(SIGNATURE)
`
`REQUEST FOR SPECIAL NOTICE
`Page two
`(Probate)
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