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Family Information Form And Urgent Concerns CV 0200 - California
| Family Information Form And Urgent Concerns Form. This is a California form and can be used in Family Yolo Local County . |
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FAMILY INFORMATION FORM AND URGENT CONCERNS This form must be completed with any petition and response in any family law, domestic violence or probate guardianship action INVOLVING MINOR CHILDREN. This form, once completed, is a confidential document. It is not Case Number: available for public viewing, but it can be viewed by the judge, the child custody recommending counselor, your attorney, the opposing attorney, and the other party. First filing of this form Subsequent filing of this form TELL US ABOUT YOURSELF AND THE OTHER PARTY TO THIS ACTION Your Last Name Other Party's Last Name Middle Name First Name Date of Birth Middle Name First Name Date of Birth Other names that you or the other party have used (for example, names from prior marriages or alias): CHILDREN 1. Has there ever been court papers filed asking for custody of the children of this marriage or relationship? YES NO YES NO If YES, in which state and county? __________________________________________ 2. Have you requested the services of the Department of Child Support Services (DCSS)? If YES, when? ____________ 3. Are you receiving or have applied for welfare? YES NO If YES, when? _________________ PLEASE LIST BELOW ALL BIOLOGICAL CHILDREN, STEP CHILDREN, ADOPTED CHILDREN AND THOSE WITH WHOM YOU HAVE LEGAL GUARDIANSHIP. First Last Name Date of Birth Sex Do you have an order giving you full or partial custody of this child? First Last Name Date of Birth M M M M Sex F F F F Relationship to you PLEASE LIST NAMES OF OTHER ADULTS LIVING IN YOUR HOME. M M M F F F Rev: 1/1/12 CV 0200 Family Information Form Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com URGENT CONCERNS Domestic Violence, Child Kidnapping, Child Sexual Abuse, Health, Schooling, Delinquency 1. Are you currently afraid of the other parent or anyone else living in the home for any reason? YES NO If yes, what is your concern? (use the back side of this form if necessary) __________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 2. Do you have concerns about the health, safety, or schooling of any children living in the home? YES NO S If yes, what is your concern? (use the back side of this form if necessary) __________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ l 3. Has Child Protective Services ever contacted you about any of your children? 4. Do you have, or are you asking for, a domestic violence restraining order? YES NO YES NO YES NO YES NO 5. If you have alleged domestic violence in a written declaration under penalty of perjury or are protected by a protective order, you have the right to have separate sessions with the child custody recommending counselor. Do you wish to be seen separately and at separate times? 6. An interpreter may be available for domestic violence matters. Do you need an interpreter? If YES, for what language? _______________________________________________ COURT AND POLICE ACTIONS Have you ever been convicted of a crime and/or put in jail or prison? YES NO If yes, please explain ___________________________________________________________________________________________________ Are there any other cases that involve you or your family in THIS county? Name of Case YES NO Case Number If yes, please complete: Are there any other cases that involve you or your family in ANOTHER COUNTY OR STATE? If yes, please complete: Name of Case Case Number County YES NO State _________________________________________________________________________________________________ Signature Date ____ _________________________________________________________________________________________________ Child Custody Recommending Counselor Signature Date Rev: 1/1/12 CV 0200 Family Information Form Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com
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