California > Local County > San Bernardino > Probate
Guardianship Questionnaire SB-18074 - California
| Guardianship Questionnaire Form. This is a California form and can be used in Probate San Bernardino Local County . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
COUNTY OF SAN BERNARDINO GUARDIANSHIP QUESTIONNAIRE (Probate Code Section 1513) Non-Relative NOTICE PLEASE BE ADVISED THE INFORMATION PROVIDED ON THIS QUESTIONNAIRE WILL BE USED TO CONDUCT A FULL AND COMPLETE INVESTIGATION OF APPLICANT'S BACKGROUND. THE RESULTS OF THE INVESTIGATION AND RELATIONSHIP HISTORIES WILL BE FULLY REPORTED TO THE COURT. I HAVE READ AND UNDERSTAND THE ABOVE CONDITIONS AND AGREE TO THEM. SIGNATURE: COMPLETE AND RETURN WITH THE PETITION. Minor's Name I. IDENTIFYING INFORMATION: PROPOSED GUARDIAN Full Name Last First Middle Relative (Relationship) Case Number Maiden Name Race/Ethnicity Language) Address Street Apt. # Language(s) spoken (Includes sign City Zip Code How long at present address? payment or rent? $ Telephone Number Age Indicate if TDD Own Rent Monthly mortgage Driver's License # Place of Birth Religion Date of Birth Social Security Number Last Grade completed and special training Were you ever arrested for an offense other than a minor traffic violation? Yes No. If yes, give date, place and details of offense (All information will be verified with the Department of Justice) PAGE 1 OF 9 2002 © American LegalNet, Inc. SB18074 Have you had previous involvement with Child Protective Services? Yes No. If yes, explain the circumstances in detail and include dates and name of County or State where involvement occurred. Have you ever been treated for or do you now have a physical impairment (e.g. hearing loss)? Yes No. If yes, explain in detail. History of mental health impairment? Yes No. If yes, explain in detail including medications, hospitalizations (when and where), and therapy/counseling (when and where). How has the addition of this child to your family impacted your family's money situation. (e.g. increased child care expenses)? SPOUSE Full Name Last First Middle Maiden Name Race/Ethnicity Language) Age Date of Birth Social Security No. Language(s) spoken (Includes sign Place of Birth Religion DL # Last Grade completed and special training Were you ever arrested for an offense other than a minor traffic violation? Yes No. If yes, give date, place and details of offense Have you had previous involvement with Child Protective Services? Yes No. If yes, explain the circumstances in detail and include dates and name of County or State where involvement occurred. PAGE 2 OF 9 2002 © American LegalNet, Inc. Have you ever been treated for or do you now have a physical impairment (e.g. hearing loss)? Yes No. If yes, explain in detail. History of mental health impairment? Yes No. If yes, explain in detail including medications, hospitalizations (when and where), and therapy/counseling (when and where). II. MARRIAGES: PROPOSED GUARDIAN Married Divorced Separated Widowed Date and place of most recent marriage Number of children Ages of Children Previous marriages (Use additional paper if necessary) Name of former spouse Date and place of marriage How terminated? State Number children from this marriage? children Who is financially supporting your minor children (include AFDC and/or Social Security benefits). Ages of Divorce Month/Year City/State Death Date Place: City and If your minor children do not currently live in your home, describe your involvement with your kids, i.e. visitations. (List each child by name.) SPOUSE Previous marriages (Use additional paper if necessary) Name of former spouse PAGE 3 OF 9 2002 © American LegalNet, Inc. Date and place of marriage How terminated? State Divorce Month/Year City/State Death Date Place: City and Number children from this marriage? children Ages of With whom do your children from previous relationships live? Who is financially supporting your minor children (include AFDC and/or Social Security benefits). If your minor children do not currently live in your home, describe your involvement with your kids, i.e. visitations. (List each child by name.) III. EMPLOYMENT/INCOME: PROPOSED GUARDIAN Name of employer/Financial support source: Address of employer: Telephone number Title SPOUSE Name of employer/Financial support source: Address of employer: Telephone number Title Length of service Gross monthly income: $ Length of service Gross monthly income: $ Who cares for children if adults are employed outside of the home? PAGE 4 OF 9 2002 © American LegalNet, Inc. IV. CHILDREN AT HOME: Use additional sheets if necessary. Name Relationship DOB Place of Birth Grade Level Special Needs V. OTHER MEMBERS OF HOUSEHOLD: Name DL # SS # Use additional sheets if necessary. Sex DOB RelationShip Occupation Criminal History VI. REFERENCES: Give name, address and telephone number of three (3) non-related references who have knowledge of your home life and standing in the community. It is preferred if one (1) is a business associate other than your employer. Full name 1. Address Full name 2. Address Full name 3. Address Number Street City Number Street Occupation City Number Street Occupation City ( ) Occupation Telephone number ( ) Zip Code Telephone number Zip Code Telephone number ( ) Zip Code VII. CHILD OR CHILDREN BEING PLACED UNDER GUARDIANSHIP: 1. a. Name Ethnicity Place of birth petitioner Month/Day/Year Other names Age Date of Birth Date placed with Relationship to petitioner Page 5 of 9 2002 © American LegalNet, Inc. Name of school Grade Phone # Teacher's name Phone # Name of physician caring for child Address of physician b. Describe known medical problems, e.g. hearing or vision impairments. Describe special needs of child and services required to meet these needs, e.g. medication - hearing aids - eyeglasses. What is your understanding of the child's mental or physical impairments. How do you plan to meet the child's mental or health problems? 2. a. Name Other names Ethnicity Age Date of Birth Place of birth Date placed with petitioner Relationship to petitioner Month/Day/Year Name of school Phone # Grade Teacher's name Name of physician caring for child Address of physician Phone # b. Describe known impairments. medical problems, e.g. hearing or vision Describe special needs of child and services required to meet these needs, e.g. medication - hearing aids - eyeglasses. PAGE 6 OF 9 2002 © American LegalNet, Inc. Describe history of mental or physical impairments. VIII. BIRTH PARENTS Mother's name Date of birth Address (if known) Mother's last contact with child. Father's name Date of birth Address (if known) Father's last contact with child. 1. What is the relationship between Petitioner and birth parents, e.g. v
|
|||||||
