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Adoption Questionnaire (For A Stepparent Or Domestic Partner Adoption) FL-E-LP-647 - California
| Adoption Questionnaire (For A Stepparent Or Domestic Partner Adoption) Form. This is a California form and can be used in Family Law Sacramento Local County . |
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In the Superior Court of the State of California FOR COURT USE ONLY (RECEIVED ON): In and for the County of Sacramento ADOPTION QUESTIONNAIRE (for a Stepparent or Domestic Partner Adoption) Case Name: CASE NUMBER: Instructions to Petitioner: In order to schedule a hearing date and begin the investigation ordered by the Court, you must complete this questionnaire and provide copies of the required documents as indicated to: SACRAMENTO COUNTY SUPERIOR COURT 3341 Power Inn Road, Family Law Sacramento, CA 95826 The questionnaire is important in introducing you and your situation to the investigator handling your case. Attach all additional documents as applicable to this questionnaire. The court will not file an incomplete packet or schedule a hearing date until all of the necessary forms are completed and submitted to the court. PETITIONER: Your current name: Maiden name and/or any other names used: Name & telephone number of your attorney: ( Your current address (Street, City, State and ZIP): How long at this address? Home Telephone: ( ) Years Months Business Telephone: ( ) ) Driver's License No. If no home or business telephone, give a contact number where the investigator can reach you: ( ) IDENTIFYING DATA OF PETITIONER: Social Security Number: Race: Eye Color: Age: Hair Color: Wgt: Date of Birth: Hgt: Place of Birth: Extent of schooling, H.S./College, etc. Insurance (Life, Health, car, etc.) specify: FL/E-LP-647 (adopted 6/10) Mandatory Adoption Questionnaire Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com MARITAL HISTORY OF PETITIONER (List all marriages) Time First Second Third Name of spouse (use maiden names) include present marriage Date of Marriage / / / / / / Date Separated / / / / / / Date & How Terminated Number of Children **Attach a certified copy of the current marriage license or Certificate of Registered Domestic Partnership** **If applicable, attach a certified copy of the final divorce judgment of each previous marriage** CHILD (List the child INVOLVED with this Court action) Name Date of Birth / / Living with Address Name of other parent Indian Ancestry? yes no Has the child ever been involved in any another court case? Yes No If so, what county ________________, case number _____________________. **Attach certified copy of the birth certificate** **If applicable, attach a certified copy of the Order of Adoption, if the minor has been previously adopted** **If applicable, attach a certified copy of the most recent court order awarding custody of the child to be adopted or an Order Terminating Parental Rights or Order Declaring Minor Free from Parental Custody and Control** **If applicable, attach a certified copy of any orders changing name** CHILDREN (List all your other children NOT INVOLVED in the Court action) Name Date of Birth / / / / / / / / Living with Address Name of other parent Since the separation of the parents of the minor(s), whom have the children been living with? Also list dates: HEALTH OF CHILDREN (List each child in this case who has recently been under the care of a Doctor, or Psychiatrist, including family physician) Child Doctor Address Date / / / / / / / / Reason FL/E-LP-647 (adopted 6/10) Mandatory Adoption Questionnaire Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Do any of the children presently have physical or mental problems? Yes No Please explain: Plan of custody/visitation: Place of residence for self and children: Will children be placed under supervision of others? Name of caretaker Relationship to children ( ) Address Phone Number What period of time ( ) State the reasons why you feel the other parent should not have custody/visitation and be specific. Give examples and dates (attach additional sheet, if needed). EMPLOYMENT Name of Employer (Beginning with your present employment, list employment for the last 5 years) Address of Employer Type of Job Date Begun Date Left / / / / / / / / Reason for Leaving / / / / Current working hours and days: MONTHLY INCOME From employment Own business Public Assistance (AFDC or Social Security Assistance) Child support Other sources TOTAL Does the petitioner pay child support? Yes If yes, is the amount in the arrears? Yes No No If yes, amount in arrears $_________ $ $ $ $ $ $ Gross $ $ $ $ $ $ Net FL/E-LP-647 (adopted 6/10) Mandatory Adoption Questionnaire Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com MEDICAL HISTORY OF PETITIONER (If either parent or guardian have any physical disability or have received psychiatric treatment or counseling, please complete the section below) Doctor & Address Hospital & Address When Treated Nature of Illness CRIMINAL RECORD OF PETITIONER: Does petitioner have a criminal record? Yes If "Yes", please give details: No Is petitioner on Probation or Parole? Yes No If "Yes", please give name of Probation Officer or Parole Agent: Area office: ( ) Phone number: ( No ) Does the petitioner have any criminal actions pending: Yes If "Yes, please explain: FL/E-LP-647 (adopted 6/10) Mandatory Adoption Questionnaire Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com NATURAL FATHER: Name of natural father: Address: Date of Birth: Occupation: Has he consented to Adoption: Yes No Place of Birth: Employer: Date of last support: Last contact with child? Race: Date of last contact with any other relative? **If applicable, attach a certified copy of the death certificate, proof of parental rights being terminated, or orders changing name ** MARITAL HISTORY OF NATURAL FATHER (List all marriages) Time First Second Third Name of spouse (use maiden names) include present marriage Date of Marriage / / / / / / Date Separated / / / / / / Date & How Terminated Number of Children Is the child a result of a donorship? Yes No Is yes, attach proof of donorship. Adoption Questionnaire (Stepparent or DP Adoption). Page 5 of 6 American LegalNet, Inc. www.FormsWorkFlow.com NATURAL MOTHER: Name of natural mother (include all names used): Date of last support: Address: Date of Birth: Occupation: Has she consented to Adoption: Yes Date of last contact with any other relative? No Place of Birth: Employer: Last contact with child? Race: **If applicable, attach a certified copy of the death certificate, proof of parental rights being terminated, or any orders changing name** MARITAL HISTORY OF NATURAL MOTHER (List all marriages) Time First Second Third Name of spouse (use maiden names) include present marriage Date of Marriage / / / / / / Date Separated
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