Kern — FCS-001

Source: https://www.kern.courts.ca.gov/system/files/general/fcs-001-identification-information-rev-112018.pdf

IDENTIFICATION INFORMATION

Thisinformationwillbeusedtoconductcreditandcriminalbackgroundchecksbythecourt.

CaseNumber

Yourfulllegalname:

Anyothernamesyouhaveused,includingmaidenname:

Yourrelationshiptotheconservatee:

YourStreetAddress:

City: ZipCode:

Phone:Residence Cell: Work:

MailingAddressifdifferent:

DateofBirth: Driver’sLicense:

PlaceofBirth: SocialSecurityNo.:

MonthlyIncome: PlaceofEmployment:

MaritalStatus: Married Single Divorced Widowed

Race: EyeColor: HairColor: Height:

I understand that I am being asked to provide my Social Security number so that the investigator can conduct a criminal background check, which will assist the investigator in making recommendations to the court, and for the court to make decisions in the case. I understand that the purpose of the investigation is to make recommendations to the court regarding whether a conservatorship is necessary and my suitability as the proposed conservator. The investigator will talk with the proposed conservatee’s relatives, caregivers, medical personnel, facility staff and any other person they deem necessary in order to provide the court with necessary information to make its decision. The investigator will redact your Social Security number from the Family Court Services’ file at the conclusion of the investigation. While the court cannot require that you provide this information, it is a great help in obtaining accurate information about your criminal background.

Date: Signature:

Printed Name:

Print Full Name of Proposed Conservatee:

FCS-001 (Mandatory Form) Rev. 11/2018 Confidential Information