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Guardianship Affidavit Questionnaire And Declaration PR-18 - California
| Guardianship Affidavit Questionnaire And Declaration Form. This is a California form and can be used in Probate San Mateo Local County . |
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SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO Guardianship Declaration Confidential Return To: Probate Court Clerk's Office 400 County Center, Redwood City, CA 94063 Name of Proposed Ward(s): Case Number: Proposed Guardian(s) Information Form Please complete this entire form and return it to the Probate Court Clerk within 5 days. Use additional sheets when necessary to answer questions. Social History of the Minor(s) Legal name of 1st minor (as on birth certificate): Name minor is known by: Place of birth: Present age: No If yes, please explain: Telephone: Is minor in counseling? Telephone: Name of school/day care facility: Telephone Grade level: No If yes, please explain: Yes No Date of Birth: Sex: M F Health Current health problems? Yes Name of minor's physician: Date of minor's last examination: Counselor's name: School/Day Care Address: Teacher's name: Are there special educational needs? Yes Are you guardian of any other children? Legal Custody Is the child subject to any legal custody orders? Yes No If yes, describe type of orders (guardianship, dissolution, paternity, adoption proceedings, hearing dates and county. Minor's Income: Savings: Social History of the 2nd Minor Legal name of 2nd minor (as on birth certificate): Name minor is known by: Place of birth: PR-18 [Rev. 4/06] Date of Birth: Present age: CONFIDENTIAL DOCUMENT Page 1 Sex: M F www.sanmateocourt.org American LegalNet, Inc. www.USCourtForms.com SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO Health Current health problems? Yes No If yes, please explain: Telephone: Is minor in counseling? Telephone: Yes No Name of minor's physician: Date of minor's last examination: Counselor's name: School/Day Care Address: Teacher's name: Name of school/day care facility: Telephone Grade level: No If yes, please explain: Are there special educational needs? Yes Are you guardian of any other children? Legal Custody Is the child subject to any legal custody orders? Yes No If yes, describe type of orders (guardianship, dissolution, paternity, adoption proceedings, hearing dates and county): Minor's income: Savings: List additional minor(s) on separate sheet(s) and include the same information as requested above. Relationship of Proposed Ward(s) to Proposed Guardians How long have you known the proposed ward(s): Briefly explain the circumstances that led to this proceeding and why the proposed ward(s) should be in your home or care: How long do you expect to be the guardian of the proposed ward(s)? Social History of the Proposed Guardian(s) Legal name: Date of birth: Social Security #: AKA's (aliases): Driver's License #: Place of birth: Residence: (House No.) (Street) Present age: (City) (State) (Zip) Telephone number: PR-18 [Rev. 4/06] Message/ cell phone: CONFIDENTIAL DOCUMENT Page 2 www.sanmateocourt.org American LegalNet, Inc. www.USCourtForms.com SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO Health Current health problems? Yes No If yes, please explain: Education Highest grade or educational level completed: List any additional training or education: Military Service Employment Employer: Address: Branch: Type/Date of Discharge: Dates Employed: Telephone: Yes No Contact Number: Additional income: Rent/mortgage payment: Occupation Can you be contacted at work? Financial Monthly income: Number of dependents: Other total monthly expenses (include child support payments): Are you planning on filing for AFDC? Yes No Are you planning on filing for Medi-Cal? Yes No Housing Rent Own Length of time in current residence? Is residence a house or an apartment? Explain: Number of bedrooms: Do you plan to remain in this location or are you looking for other accommodations? Accommodations for proposed ward: Marital History Number of previous marriages: Date and place of current marriage: Names of your children Birthdate(s) Drivers License: Address: Phone: Please provide the following information for other persons 16 years of age and above residing in the home: Names Birthdate(s) Drivers License: Relationship: PR-18 [Rev. 4/06] CONFIDENTIAL DOCUMENT Page 3 www.sanmateocourt.org American LegalNet, Inc. www.USCourtForms.com SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO Social History of the Present Spouse/Cohabitant Legal name: Date pf Birth: SS#: Residence: (House No.) Telephone number (day): (Street) (City) (State) (Zip) Telephone number (evening): No If yes, please explain: Place of Birth: Driver's License #: AKA's (aliases): Present age: State: Health Current health problems? Yes Education Highest grade or educational level completed: List any additional training or education: Military Service Employment Employer: Address: Branch: Type/Date of Discharge: Dates Employed: Telephone: Yes No Contact Number: Occupation Can spouse/cohabitant be contacted at work? Marital History Number of previous marriages: Birthdate(s) Drivers License: Address: Phone: Names of Spouse's /Cohabitant's Children: List persons who are familiar with the history of the minor's parents: (Name & Relationship) (Name & Relationship) (Street) (Street) (City) (City) (State) (State) (Zip) (Zip) (Daytime Phone #) (Daytime Phone #) (Name & Relationship) (Street) (City) (State) (Zip) (Daytime Phone #) Birth/Legal Parents continued on next page The Court Investigator may attempt to contact the parents, if current information is needed. PR-18 [Rev. 4/06] CONFIDENTIAL DOCUMENT Page 4 www.sanmateocourt.org American LegalNet, Inc. www.USCourtForms.com SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO Birth/Legal Father's Name Residence: (House No.) Telephone number: Employer: Does the minor(s) see the father? Yes No Explain: Yes No (Street) SS#: (City) (State) DL# Telephone: (Zip) Date of birth: Has the father provided any financial support for the child(ren)? If yes, how much? Is the father in agreement with this proceeding? Yes No Date of payments: Birth/Legal Mother's Name Residence: (House No.) (Street) (City) Date of birth: (State) (Zip) Telephone number: Employer: Does the minor(s) see the mother? Yes SS#: DL# Telephone: No Explain: Yes No Has the mother provided any financial support for the child(ren)? If yes, how much? Is the mother in agreement with this proceeding? Date of payments: Yes No You may be charged for the cost of this investigation pursuant to Probate Code Section 1513.1 I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct to the best of my knowledge. Dated: Signature: Pr
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