San Diego — Guardianship Questionnaire - Estate PR-064 (Rev: 02/17)

Source: https://www.sdcourt.ca.gov/sites/default/files/sdcourt/generalinformation/forms/probateforms/pr064.pdf

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CONFIDENTIAL

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

TELEPHONE NO.: FAX NO.(Optional):

EMAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, CENTRAL COURTHOUSE, 1100 UNION ST., SAN DIEGO, CA 92101 CENTRAL DIVISION, MADGE BRADLEY, 1409 4TH AVE., SAN DIEGO, CA 92101 GUARDIANSHIP OF: JUDGE

GUARDIANSHIP QUESTIONNAIRE – ESTATE CASE NUMBER
(CONFIDENTIAL)

NOTE: EACH PROPOSED GUARDIAN MUST SUBMIT A SEPARATE QUESTIONNAIRE.

1. MINOR(S): Name: Address: Date of birth:

2. PARENT(S): Mother’s Name: Address: Telephone No.:

Father’s Name: Address: Telephone No.:

3. CUSTODY: a. Name, relationship to minor, and address of person(s) with physical custody of minor(s):

   b. Name, relationship to minor, and address of person(s) with legal custody of minor(s):

4. PROPOSED GUARDIAN: a. Name: Address: Telephone No.:

   b. Relationship to minor: c. Date of birth: d. Place of birth:

5. PROPOSED GUARDIAN'S BACKGROUND: a. Employed by: b. Length of employment (years/months): Gross Monthly Income: $ c. Position Title:

SDSC PR-064 (Rev. 2/17) GUARDIANSHIP QUESTIONNAIRE - ESTATE Prob. Code § 1513 Mandatory Form (CONFIDENTIAL) Page 1 of 3

d. Supervisor's name, address and phone:

e. Length of time in San Diego County (years):
f. Length of time at current address (years):
g. Is proposed guardian a U.S. citizen? YES NO
If no, explain:

6. PROPOSED GUARDIAN'S FINANCIAL HISTORY a. Residence: RENT, $ /mo. OWN, Value: $ Equity: $ b. Other assets (include approximate value):

   Continued on attachment 6b.

   c. Income other than salary (include sources):

   Continued on attachment 6c.

   d. Current liabilities. List each account and liability amount (e.g. credit card debt, loans, contracts):

   Account: Amount: Account: Amount:
   1) ___________________ $________ 4) ___________________ $________
   2) ___________________ $________ 5) ___________________ $________
   3) ___________________ $________ 6) ___________________ $________
   Continued on attachment 6d.

   e. Are any of the accounts for the liabilities listed above in a delinquent status: YES NO If yes, list account(s) and explain: ________________________________________________________________

   ---

   ---

   Continued on attachment 6e.

   f. Have you ever filed bankruptcy? YES NO If yes, explain: Continued on attachment 6f. g. Have you ever been convicted of fraud, embezzlement or any other felony involving financial matters? YES NO If yes, explain: Continued on attachment 6g. h. Are you indebted to the minor or do you have a claim against the estate of the minor? YES NO If yes, explain: Continued on attachment 6h.

SDSC PR-064 (Rev. 2/17) GUARDIANSHIP QUESTIONNAIRE - ESTATE Prob. Code § 1513 Mandatory Form (CONFIDENTIAL) Page 2 of 3

i. Are there any actions pending against you by the Internal Revenue Service? YES NO If yes, explain:

Continued on attachment 6i.
j. Have you ever served as a guardian, trustee, custodian, conservator, under a power of attorney, or in any other
fiduciary capacity? YES NO
If yes, explain when, where, of whom, is it continuing or terminated, and why:

Continued on attachment 6j.

7. MINOR'S ESTATE a. Expected value of estate and income (include sources):

   Continued on attachment 7a.

   b. Social Security income: $_______________/mo. c. Name of medical insurer: ______________________________. $/mo. d. Guardian's plans for minor's estate

   Continued on attachment 7d.

   e. Guardian's plans for support of minor

   Continued on attachment 7a.

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

Date:

Type or print name Signature of Proposed Guardian

SDSC PR-064 (Rev. 2/17) GUARDIANSHIP QUESTIONNAIRE - ESTATE Prob. Code § 1513 Mandatory Form (CONFIDENTIAL) Page 3 of 3 Clear This Form