San Mateo — Guardianship Declaration Confidential

Source: https://sanmateo.courts.ca.gov/system/files/local-forms/pr-18.pdf

SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO Guardianship Declaration Confidential Probate Court Clerk’s OfficeReturn To: 400 County Center, Redwood City, CA 94063 Name of Proposed Ward(s):

Case Number:

Proposed Guardian(s) Information Form

Please complete this entire form and return it to the Probate Court Clerk at the time of filing. Use additional sheets when necessary to answer questions.

Social History of the Minor(s)

Legal name of 1st minor (as on birth certificate): Name minor is known by: Date of Birth: Place of birth: Present age: Sex: M F

Health Current health problems? Yes No If yes, please explain:

Name of minor’s physician: Telephone: Date of minor’s last examination: Is minor in counseling? Yes No Counselor’s name: Telephone:

School/Day Care Name of school/day care facility: Address: Telephone

Teacher’s name: Grade level:

Are there special educational needs? Yes No If yes, please explain:

Are you guardian of any other children?

Is the child subject to any legal custody orders? Yes No

Legal Custody If yes, describe type of orders (guardianship, dissolution, paternity, adoption proceedings, hearing dates and county.

Minor’s Income: Savings:

Social History of the 2nd Minor

Legal name of 2nd minor (as on birth certificate): Name minor is known by: Date of Birth: Place of birth: Present age: Sex: M F

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SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO

Health Current health problems? Yes No If yes, please explain:

Name of minor’s physician: Telephone: Date of minor’s last examination: Is minor in counseling? Yes No Counselor’s name: Telephone:

School/Day Care Name of school/day care facility: Address: Telephone

Teacher’s name: Grade level:

Are there special educational needs? Yes No If yes, please explain:

Are you guardian of any other children?

Is the child subject to any legal custody orders? Yes No

Legal Custody If yes, describe type of orders (guardianship, dissolution, paternity, adoption proceedings, hearing dates and county):

Minor’s income: Savings:

List additional minor(s) on separate sheet(s) and include the same information as requested above.

Relationship of Proposed Ward(s) to Proposed Guardians

How long have you known the proposed ward(s): Briefly explain the circumstances that led to this proceeding and why the proposed ward(s) should be in your home or care:

How long do you expect to be the guardian of the proposed ward(s)?

Social History of the Proposed Guardian(s)

Legal name: AKA’s (aliases):

Date of birth: Social Security #: Driver’s License #: Place of birth: Present age: Residence: (House No.) (Street) (City) (State) (Zip) Telephone number: Message/ cell phone:

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SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO

Health Current health problems? Yes No If yes, please explain:

Education Highest grade or educational level completed:

List any additional training or education:

Military Service Branch: Type/Date of Discharge:

Employment Occupation Dates Employed: Employer: Telephone: Address:

Can you be contacted at work? Yes No Contact Number:

Financial Monthly income: Additional income:

Number of dependents: Rent/mortgage payment:

Other total monthly expenses (include child support payments):

Are you planning on filing for AFDC? Yes No Are you planning on filing for Medi-Cal? Yes No

Housing Rent Own Length of time in current residence? Number of bedrooms: Is residence a house or an apartment?

Do you plan to remain in this location or are you looking for other accommodations? Explain:

Accommodations for proposed ward:

Marital History Number of previous marriages:

Date and place of current marriage:

Names of your children Birthdate(s) Drivers License: Address: Phone:

Please provide the following information for other persons 16 years of age and above residing in the home: Names Birthdate(s) Drivers License: Relationship:

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SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO

Social History of the Present Spouse/Cohabitant

Legal name: AKA’s (aliases):

Date pf Birth: Place of Birth: Present age:

SS#: Driver’s License #: State: Residence: (House No.) (Street) (City) (State) (Zip)

Telephone number (day): Telephone number (evening):

Health Current health problems? Yes No If yes, please explain:

Education Highest grade or educational level completed:

List any additional training or education:

Military Service Branch: Type/Date of Discharge:

Dates

Employment Occupation Employed: Employer: Telephone: Address:

Can spouse/cohabitant be contacted at work? Yes No Contact Number:

Marital History Number of previous marriages:

Names of Spouse’s /Cohabitant’s Children: Birthdate(s) Drivers License: Address: Phone:

List persons who are familiar with the history of the minor’s parents:

(Name & Relationship) (Street) (City) (State) (Zip) (Daytime Phone #)

(Name & Relationship) (Street) (City) (State) (Zip) (Daytime Phone #)

(Name & Relationship) (Street) (City) (State) (Zip) (Daytime Phone #)

Birth/Legal Parents The Court Investigator may attempt to contact the parents, if current information is needed.

continued on next page

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SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO

Birth/Legal Father’s Name Date of birth: Residence: (House No.) (Street) (City) (State) (Zip)

Telephone number: SS#: DL#

Employer: Telephone:

Does the minor(s) see the father? Yes No Explain:

Has the father provided any financial support for the child(ren)? Yes No

If yes, how much? Date of payments:

Is the father in agreement with this proceeding? Yes No

Birth/Legal Mother’s Name Date of birth: Residence: (House No.) (Street) (City) (State) (Zip)

Telephone number: SS#: DL#

Employer: Telephone:

Does the minor(s) see the mother? Yes No Explain:

Has the mother provided any financial support for the child(ren)? Yes No

If yes, how much? Date of payments:

Is the mother in agreement with this proceeding? Yes No

You may be charged for the cost of this investigation pursuant to Probate Code Section 1513.1

I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct to the best of my knowledge.

Dated: at: , California

Signature:

Print or type your name:

Note: If another person filled out this document for you, that person must also sign the acknowledgment under penalty of perjury.

Dated: at: , California

Signature:

Print or type your name:

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SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO

Release of Information - Consent Form (Please Print)

I, , DOB: hereby give my consent

, DOB: hereby give my consent

, DOB: hereby give my consent

to , Court Investigator of the Superior Court of San Mateo County, to obtain information from Children and Family Services regarding any records that agency may have pertaining to me.

Signature Date

Signature Date

Signature Date

Witness Date

Case Name - Minor(s)

Case Number:

Court Hearing Date:

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