Sutter — Guardianship Investigation Questionnaire

Source: https://www.sutter.courts.ca.gov/system/files/general/fl-05-guardianship-investigation-questionnaire-4-2026.pdf

SUPERIOR COURT OF CALIFORNIA COUNTY OF SUTTER

1175 Civic Center Blvd., Yuba City, CA 95993

STEPHANIE M. HANSEL Court Executive Officer

THIS QUESTIONNAIRE IS DUE WHEN THE PETITION IS FILED.

GUARDIANSHIP INVESTIGATION QUESTIONNAIRE

This questionnaire is for the Court Investigator’s use only and will not be shared with any outside party. Please make sure it is complete and neat.

Please return this completed questionnaire to Sutter County Superior Court 1175 Civic Center Blvd. Yuba City, CA 95993.

If you have any questions, please contact the investigators at (530) 822-3332

GUARDIANSHIP INVESTIGATION QUESTIONNAIRE

Superior Court of California, County of Sutter FL-05 Optional Form Page 1 of 9 (Revised 04/13/2026)

SUPERIOR COURT OF CALIFORNIA COUNTY OF SUTTER

1175 Civic Center Blvd., Yuba City, CA 95993

STEPHANIE M. HANSEL Court Executive Officer

AUTHORIZATION FOR RELEASE OF INFORMATION

I, , specifically authorize any public
agency, private person, employer or past employer, school, medical doctor, psychologist,
treating therapist or hospital possessing information about me or my children (listed below),
including psychiatric information, confidential or otherwise, to release same (including copies) to
the Superior Court through its duly appointed Court Investigator, such information to be used as
the Court may deem fit and proper.

A copy of this release shall be as valid as the original.

This release shall remain in effect for one year from the date of my signature, unless otherwise
revoked.

Child’s Full Name Date of Birth

(Use back of this form for additional space, if needed)

Date Authorizing Signature

Date Court Investigator

GUARDIANSHIP INVESTIGATION QUESTIONNAIRE

Superior Court of California, County of Sutter FL-05 Optional Form Page 2 of 9 (Revised 04/13/2026)

Today’s Date: ______________________

Court Case Number: _________________________________

Your Attorney’s Name: ________________________________

Your Attorney’s Telephone Number: _____________________

You are the: ☐Mother
☐ Father
☐ Proposed Guardian, Relationship to Child(ren): ________________________

Your Full Name (including middle name): __________________________________________

Other Names Used (include maiden name): ________________________________________

Current Address: ___________________________________________________________

___________________________________________________________

Telephone Numbers: Home: ____________________

Work: ____________________

Cell: _____________________

Email Address: _________________________________

Social Security Number: __________________________

Driver’s License Number: _________________________

Date of Birth: ___________________ Place of Birth: _______________________________

How Long Have You Lived In: California? _______________

Sutter County? ____________

GUARDIANSHIP INVESTIGATION QUESTIONNAIRE

Superior Court of California, County of Sutter FL-05 Optional Form Page 3 of 9 (Revised 04/13/2026)

List all people who currently reside in your home:

Full Name (including middle name) Date of Birth Relationship to Driver’s License & (all names used) You Social Security Number

How long have you lived at your current address? ____________________________

List all of your home addresses for the last five years, beginning with the present:

Address Dates Reason for Moving

GUARDIANSHIP INVESTIGATION QUESTIONNAIRE

Superior Court of California, County of Sutter FL-05 Optional Form Page 4 of 9 (Revised 04/13/2026)

List your last three employers, beginning with present:

Name Address Position Date Started Date Left/Reason

Current days and hours you work: __________________________________________________

Amount of income per month: _____________________________________________________

Your source of income if you are not employed: _______________________________________

List Any Proposed or Current Childcare Providers:

Provider’s Name Address Telephone Days and Times
Number

Your Current Spouse: ____________________________________________________________

Other Names Used (Include Maiden Name): ________________________________________

Date and Place of Birth: ________________________________________________________

Driver’s License Number: _______________________________________________________

Social Security Number: ________________________________________________________

Employer Name and Address: ___________________________________________________

Occupation: _________________________________________________________________

Days and Hours of Work: _______________________________________________________

GUARDIANSHIP INVESTIGATION QUESTIONNAIRE

Superior Court of California, County of Sutter FL-05 Optional Form Page 5 of 9 (Revised 04/13/2026)

List all of your children and any children involved in this matter, including adults:

1. Child’s Full Name: _________________________________________________________________

Date and Place of Birth: _______________________________________ Age: __________

School and Grade: __________________________________________________________

Other Parent’s Name: ______________________________________________________________

Custody and Visitation Order: __________________________________________________

2. Child’s Full Name: _________________________________________________________________

Date and Place of Birth: _______________________________________ Age: __________

School and Grade: __________________________________________________________

Other Parent’s Name: ______________________________________________________________

Custody and Visitation Order: __________________________________________________

3. Child’s Full Name: _________________________________________________________________

Date and Place of Birth: _______________________________________ Age: __________

School and Grade: __________________________________________________________

Other Parent’s Name: ______________________________________________________________

Custody and Visitation Order: __________________________________________________

4. Child’s Full Name: _________________________________________________________________

Date and Place of Birth: _______________________________________ Age: __________

School and Grade: __________________________________________________________

Other Parent’s Name: ______________________________________________________________

Custody and Visitation Order: __________________________________________________

GUARDIANSHIP INVESTIGATION QUESTIONNAIRE

Superior Court of California, County of Sutter FL-05 Optional Form Page 6 of 9 (Revised 04/13/2026)

List all of the above listed children’s medical doctors and mental health counselors/therapists:

Provider’s Name Telephone Number Reason for Seeing Child’s Name

Describe your health:

---

---

List all medications you take:

Name Dosage Reason

Describe your history of alcohol and/or illegal drug use:

---

---

List your medical doctors and mental health counselors/therapists:

Provider’s Name Telephone Number Reason for Seeing Dates of Treatment

GUARDIANSHIP INVESTIGATION QUESTIONNAIRE

Superior Court of California, County of Sutter FL-05 Optional Form Page 7 of 9 (Revised 04/13/2026)

Your criminal history:

Date of Arrest Arresting Agency Charge(s) Disposition

Your Child Protective Services history:

Date of Contact County Reason Result

Describe the current contact between the parents and the child(ren):

---

---

---

---

---

GUARDIANSHIP INVESTIGATION QUESTIONNAIRE

Superior Court of California, County of Sutter FL-05 Optional Form Page 8 of 9 (Revised 04/13/2026)

List the names and addresses of the following relatives of the child(ren) of whom you are seeking guardianship:

Name Address and Telephone Number

Mother:

Father:

Maternal
Grandmother:

Maternal
Grandfather:

Paternal
Grandmother:

Paternal
Grandfather:

Siblings:

I declare under penalty of perjury under the laws of the State of California that the information above
is true and correct.

Date:

---

Print Name Sign Name

GUARDIANSHIP INVESTIGATION QUESTIONNAIRE

Superior Court of California, County of Sutter FL-05 Optional Form Page 9 of 9 (Revised 04/13/2026)