San Diego — Guardianship Termination Questionnaire (Confidential) FCS-039 (Rev: 12/17)

Source: https://www.sdcourt.ca.gov/sites/default/files/sdcourt/generalinformation/forms/familyandchildrenforms/fcs039.pdf

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CONFIDENTIAL

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, CENTRAL COURTHOUSE, 1100 UNION ST., SAN DIEGO, CA (619) 844-2888

GUARDIANSHIP TERMINATION QUESTIONNAIRE (CONFIDENTIAL)

NOTICE TO PETITIONERS

When seeking termination of guardianship of a child(ren) to whom you are related, in order to begin the Family Court Services (FCS) investigation process, copies of the following documents that were filed in the probate business office, must be submitted to FCS at the address listed above, prior to scheduling an investigation date:

1. Petition for Termination of Guardianship (JC Form #GC-255)
2. Either an Order Directing or Waiving Investigation (SDSC Form #PR-063) signed by a judge of the Superior Court or a Family Court Services Referral (SDSC Form #FCS-037) request from a judge of the Superior Court directing FCS to conduct a termination investigation.
3. Family Court Services Guardianship Termination Questionnaire (SDSC Form #FCS-039) (Provided only to Family Court Services).

You may mail the information to the San Diego FCS office at 1100 Union St., Room 430, San Diego, California 92101. You may also walk-in and drop your paperwork off from 8:00 a.m. - 12:00 p.m. and 1:00 p.m. – 4:00 p.m. Monday through Friday.

Complete the attached seven page Guardianship Termination Questionnaire in its entirety, and bring all documentation requested in the questionnaire, including proof of residence and employment, parenting class certificates, treatment programs, etc.

Information provided on this questionnaire, in the family interview(s), in other submitted comments and from investigative sources, will be used to prepare a recommendation to the court. This report will then be placed in a sealed court file. Copies will be issued to the petitioner, guardians, parents and their respective attorneys.

You may call the Guardianship Clerk at the number listed above with questions regarding the FCS termination investigation process, or concerns regarding appointments.

The petitioner is responsible for notifying the guardians regarding the FCS investigation interview appointment. Any adult living in the home and acting in a parental role should be present for the interview.

Do not bring the child(ren) to the FCS appointment. A subsequent appointment will be scheduled should the investigator need to interview the children.

SDSC FCS-039 (Rev. 12/17) GUARDIANSHIP TERMINATION QUESTIONNAIRE Page 1 of 8 Mandatory Form (CONFIDENTIAL)

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO

FAMILY COURT SERVICES

GUARDIANSHIP TERMINATION QUESTIONNAIRE

THIS FORM IS TO BE COMPLETED AND SUBMITTED TO FAMILY COURT SERVICES BY: Your appointment will not be set until this form has been returned to Family Court Services.

COUNSELOR: PROBATE CASE NUMBER:

COURT DATE: FCS DATE:

I. MINOR CHILD(REN) LISTED ON GUARDIANSHIP TERMINATION PETITION:

Social Security Person with
Full Legal Name Birth Date School and Grade Level
Number whom Residing

Attorney for Minor(s):

Name: Tel. No.: ( )

Address:
Street Ste. City State Zip Code

II. PETITONER(S) FOR TERMINATION OF GUARDIANSHIP:

1. Full Legal Name: AKA or Maiden Name:

Address:
Street Apt. City State Zip Code

Telephone Numbers: Home ( ) Work ( )

Social Security Number: _________________ Birth Date: // Place of Birth:

Driver License Number: State: _________________ Currently Valid: Yes No

Relationship to Child(ren) on Petition: Maternal Paternal

2. Full Legal Name: AKA or Maiden Name:

Address:
Street Apt. City State Zip Code

Telephone Numbers: Home ( ) Work ( )

Social Security Number: _________________ Birth Date: // Place of Birth:

Driver License Number: State: _________________ Currently Valid: Yes No

Relationship to Child(ren) on Petition: Maternal Paternal

Attorney for Petitioner(s):

Name: Tel. No.: ( )

Address:
Street Ste. City State Zip Code

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III. CURRENT GUARDIAN(S):

1. Full Legal Name: AKA or Maiden Name:

Address:
Street Apt. City State Zip Code

Telephone Numbers: Home ( ) Work ( )

Social Security Number: ____________________ Birth Date: //____ Place of Birth: ___________________

Driver License Number: ____________________________State: _______________ Currently Valid: Yes No

Relationship to Child(ren) on Petition: Maternal Paternal

Attorney for Guardian(s):

Name: Tel. No.: ( )

Address:
Street Ste. City State Zip Code

2. Full Legal Name AKA or Maiden Name:

Address:
Street Apt. City State Zip Code

Telephone Numbers: Home ( ) Work ( )

Social Security Number: ____________________Birth Date: //____Place of Birth: ____________________

Driver License Number: _____________State: Currently Valid: Yes No

Relationship to Child(ren) on Petition: Maternal Paternal

Attorney for Guardian(s):

Name: Tel. No.: ( )

Address:
Street Ste. City State Zip Code

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IV. PARENTS OF MINORS: (Full legal names) If one of the natural parents has died, please mark “deceased” for that person’s address and add the date of death, if known.

1. Full Legal Name: AKA or Maiden Name:

Address:
Street Apt. City State Zip Code

Telephone Numbers: Home ( ) Work ( )

Social Security Number: Birth Date: / / Place of Birth:

Driver License Number: State: Currently Valid: Yes No

Relationship to Child(ren) on Petition:

Attorney:

Name: Tel. No.: ( )

Address:
Street Ste. City State Zip Code

2. Full Legal Name: AKA or Maiden Name:

Address:
Street Apt. City State Zip Code

Telephone Numbers: Home ( ) Work ( )

Social Security Number: Birth Date: / / Place of Birth:

Driver License Number: State: Currently Valid: Yes No

Relationship to Child(ren) on Petition:

Attorney:

Name: Tel. No.: ( )

Address:
Street Ste. City State Zip Code

3. Full Legal Name: AKA or Maiden Name:

Address:
Street Apt. City State Zip Code

Telephone Numbers: Home ( ) Work ( )

Social Security Number: Birth Date: / / Place of Birth:

Driver License Number: State: Currently Valid: Yes No

Relationship to Child(ren) on Petition:

Attorney:

Name: Tel. No.: ( )

Address:
Street Ste. City State Zip Code

4. Full Legal Name: AKA or Maiden Name:

Address: Street Apt. City State Zip Code Telephone Numbers: Home ( ) Work ( )

Social Security Number: Birth Date: / / Place of Birth:

Driver License Number: State: Currently Valid: Yes No

Relationship to Child(ren) on Petition:

Attorney:

Name: Tel. No.: ( )

Address:
Street Ste. City State Zip Code

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V. HOUSEHOLD COMPOSITION OF PARTY REQUESTING TO PROVIDE THE CHILD(REN)’S RESIDENCE:

A. List other adults 18 or older residing in your home. Indicate if they are acting in a parental role with the child(ren).
***(Any individuals acting in a parental role will be required to attend the investigation interview).

1. Full Legal Name: AKA or Maiden Name:

Telephone Numbers: Home ( ) Work ( )

Birth Date: / / Birth Place: _______Sex: Social Security Number: ________________
Driver License Number: State: Currently Valid: Yes No

Relationship to Applicant: Relationship to child(ren):

2. Full Legal Name: AKA or Maiden Name:

Telephone Numbers: Home ( ) Work ( )

Birth Date: / / Birth Place: _______Sex: Social Security Number: ________________
Driver License Number: State: Currently Valid: Yes No

Relationship to Applicant: Relationship to child(ren):

3. Full Legal Name: AKA or Maiden Name:

Telephone Numbers: Home ( ) Work ( )

Birth Date: / / Birth Place: _______Sex: Social Security Number: ________________
Driver License Number: State: Currently Valid: Yes No

Relationship to Applicant: Relationship to child(ren):

4. Full Legal Name: AKA or Maiden Name:

Telephone Numbers: Home ( ) Work ( )

Birth Date: / / Birth Place: _______Sex: Social Security Number: ________________
Driver License Number: State: Currently Valid: Yes No

Relationship to Applicant: Relationship to child(ren):

B. List other child(ren) under age 18 living in your household:

Social Security
Name Birth Date School
Number

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The remaining sections are to be completed regarding the party requesting to provide the child(ren)’s residence.

Name: Relationship: (Please Print)

VI. LAW ENFORCEMENT INFORMATION:

Have charges ever been filed against you for crimes other than minor traffic citations?

Yes No If yes, please explain:
Charge City/State Date

1)

2)

3)

Are you on parole or probation? Yes No

Parole or Probation Officer’s Name: Tel. No.: ( )

Have you or anyone living in your home ever been accused of child abuse or child molestation?

Yes No If yes, please explain:

VII. EDUCATION:

Highest Grade Completed: Graduated High School? Yes No Year:

License(s) or Credential(s) Received:

College Degree(s) Received:

VIII. EMPLOYMENT: Please bring confirmation of employment, including pay stubs, to the investigation interview.

Employer: Capacity/Job Title:

Length of Employment: Salary:

Supervisor’s Name, Address and Phone Number:

IX. HEALTH:

Name of Your Health Insurance Plan:

Present Health Status: Good Fair Poor

If your health is fair or poor, Please explain:

Are you taking any medication? Yes No

If yes, what kind and for what reason(s)?

Special Health Problems:

Have you ever had any problem with the following?

Alcohol: Yes No Drugs: Yes No Mental/Emotional Problems: Yes No

If yes, what is your current condition regarding this problem? (Bring proof of treatment to investigation interview)

Professional Practitioners: (Medical doctors, psychotherapists, counselors who may have treated you within the past two years.)

Date of Last Phone
Name and Title Address
Contact Number

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X. FAMILY FINANCES:

Residence: Please provide proof of residence, e.g. rental agreement, at investigation interview.

The home you live in is: owned rented.

How long have you lived there? Monthly Cost: $ Value: $

Number of Bedrooms: Number of Bathrooms: Approximate Size: sq.ft.

Income: Please list source(s) of income and amount(s).
Income Source Amount

1.

2.

3.

Other Assets: Please list other major assets or real property.
Asset Value

1.

2.

3.

XI. PLANS FOR CHILD CARE: (If necessary)

Care Provider(s):

Relationship
Name Address Phone Number Hours
to Child

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XII. SUMMARY OF CIRCUMSTANCES:

1. Briefly summarize the reasons why you are requesting termination of the guardianship. You may attach
declarations which are being provided to the court in this regard.

2. What is the guardian’s opinion regarding your request for termination of the guardianship?

3. List any parenting classes or additional programs in which you have participated that you feel enhance your ability
to parent. Please provide certificates of completion at the investigation interview.

4. Please describe the contact you have had with the child(ren) since the guardianship has been in effect.

I declare under penalty of perjury under the laws of the State of California that all of the information I have submitted in this Guardianship Termination Questionnaire is true and correct.

Date:

SIGN

Type or print name Signature

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