Authorization For Release Of Information {PB-4014}

ATTACHMENT PB-4014 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address): TELEPHONE NUMBER: FOR COURT USE ONLY ATTORNEY FOR (Name): Self-Represented SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA COURT ADDRESS: 191 North First Street, San José, California 95113 PHONE NUMBER: FAX NUMBER: BRANCH NAME: (408) 882-2651 (408) 882-2693 Downtown Courthouse ­ Probate Division In the Matter of the Guardianship of: CASE NUMBER: AUTHORIZATION FOR RELEASE OF INFORMATION Probate Code Section 1513 requires that a probate court investigator conduct interviews and write a report and recommendation to the Court concerning the appropriateness of establishing a guardianship for the above-named children. In order to assist in the gathering of pertinent information, I/we, / specifically authorize the release of my/our school records, counseling records, probation records, public and private social service records, summaries of medical and psychological records, and records from any private or public agency which would assist in determination of our petition for guardianship. Dated: Dated: Original to: Probate Court Investigator PB-4014 REV 1/01/14 (For Optional Use) AUTHORIZATION FOR RELEASE OF INFORMATION Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com