Ventura — Guardianship Questionnaire (Probate Code Section 1513)

Source: https://ventura.courts.ca.gov/system/files/vn042.pdf

VN042 CONFIDENTIAL SUPERIOR COURT OF CALIFORNIA COUNTY OF VENTURA

GUARDIANSHIP QUESTIONNAIRE (Probate Code Section 1523)

THIS FORM MUST BE COMPLETED AND FILED WITH THE PETITION

Proposed Guardian(s) must attach proof of each child’s date of birth. The proof can be a copy of a birth certificate, custody order, declaration of a person present at birth or school records showing the date of birth. If the Proposed Guardians are legally married or registered domestic partners, they can complete and submit one joint form. If they are not legally married or registered domestic partners, each Proposed Guardian would complete and submit a separate form.

CHILD(REN)’S NAME(S):

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CASE NUMBER: _______________________________________________________

SECTION I – SOCIAL HISTORY

PROPOSED GUARDIAN’S FULL LEGAL NAME: __________________________________________________________________ LIST ALL FORMER/OTHER NAME(S) USED: ______________________________________________________________________

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ADDRESS: ____________________________________________________________________________________________________ HOW LONG HAVE YOU LIVED AT PRESENT ADDRESS? __________________________________________________________ LIST ADDRESSES FOR PAST 3 YEARS: __________________________________________________________________________

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PHONE: (_____) _______________________________ AGE: ____________ DATE OF BIRTH: _____________________________ DRIVER’S LICENSE#: ______________________________ STATE LICENSE ISSUED: ___________________________________ RELATIVE TO THE CHILD(REN) NON-RELATIVE TO THE CHILD(REN) DESCRIBE ANY MEDICAL PROBLEMS: __________________________________________________________________________

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SPOUSE’S/REGISTERED DOMESTIC PARTNER’S FULL LEGAL NAME:

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LIST ALL FORMER/OTHER NAME(S) USED:

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AGE: ____________ DATE OF BIRTH: _______________ DRIVER’S LICENSE # ________________________________ STATE LICENSE ISSUED ______________________ RELATIVE TO THE CHILD(REN) NON-RELATIVE TO THE CHILD(REN) DESCRIBE ANY MEDICAL PROBLEMS: __________________________________________________________________________

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Mandatory Form GUARDIANSHIP QUESTIONNAIRE Page __ of __ VN042 (Rev. 07/24) CONFIDENTIAL

VN042 CHILD(REN)’S NAME(S): CASE NUMBER:

SECTION II – MARRIAGES

NEVER MARRIED MARRIED DIVORCED SEPARATED WIDOWED DATE AND PLACE OF PRESENT MARRIAGE: ____________________________________________________________________ NAMES AND AGES OF CHILDREN: _____________________________________________________________________________ PREVIOUS MARRIAGE, IF APPLICABLE. NAME OF FORMER SPOUSE: __________________________________________________________________________________ DATE AND PLACE OF MARRIAGE: ____________________________________________________________________________ DATE AND PLACE OF DIVORCE/DEATH: _______________________________________________________________________ NAMES AND AGES OF CHILDREN FROM FORMER MARRIAGE: ___________________________________________________

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SPOUSE’S/REGISTERED DOMESTIC PARTNER’S PREVIOUS MARRIAGE, IF APPLICABLE. NAME OF FORMER SPOUSE: _________________________________________________________________________________ DATE AND PLACE OF MARRIAGE: ____________________________________________________________________________ DATE AND PLACE OF DIVORCE/DEATH: ______________________________________________________________________ NAMES AND AGES OF CHILDREN FROM FORMER MARRIAGE: __________________________________________________

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SECTION III- EMPLOYMENT

PROPOSED GUARDIAN – NAME AND ADDRESS OF EMPLOYER: _________________________________________________

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PHONE: ()_________________________ LENGTH OF SERVICE: _____________________________________________ POSITION: ____________________________________________________________________ DAYS AND HOURS OF WORK: __________________________________________________

SPOUSE/REGISTERED DOMESTIC PARTNER – NAME AND ADDRESS OF EMPLOYER

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PHONE: ()________________________ LENGTH OF SERVICE ____________________________________________ POSITION _____________________________________________________________________ DAYS AND HOURS OF WORK ___________________________________________________

EXPLAIN HOW THE PROPOSED GUARDIAN(S) WILL BE ABLE TO FINANCIALLY SUPPORT THE CHILD(REN):

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Mandatory Form GUARDIANSHIP QUESTIONNAIRE Page __ of __VN042 (Rev. 07/24) CONFIDENTIAL

VN042 CHILD(REN)’S NAME(S): CASE NUMBER:

SECTION IV - OTHER MEMBERS OF HOUSEHOLD

NAME DATE OF BIRTH RELATIONSHIP

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SECTION V - CHILD(REN) BEING PLACED UNDER GUARDIANSHIP

1. NAME: _______________________________________________________ AGE: ___________ DOB: ______________________ RELATIONSHIP TO PROPOSED GUARDIAN(S) ________________________________________________________________ IS THIS CHILD LIVING WITH YOU, THE PROPOSED GUARDIAN(S), NOW? YES NO IF YOU ANSWERED YES, PLEASE STAT HOW AND WHEN THEY STARTED LIVING WITH YOU: __________________________________________________________________________________________________________

SCHOOL: ____________________________________________________________ PHONE: () _____________________ CHILDCARE: ______________________________ PHONE: () ___________________ DAYS/TIMES: _______________ DOCTOR: ____________________________________ PHONE: (______) _____________________ DOES THE CHILD HAVE ANY MEDICAL, DEVELOPMENTAL OR MENTAL HEALTH ISSUES? YES NO IF YOU ANSWERED YES, BRIEFLY STAT WHAT THE ISSUES ARE: _________________________________________________________________________________________________________ DOES THIS CHILD HAVE AN IEP OR 504 EDUCATION PLAN WITH THEIR SCHOOL? YES NO

2. NAME: _____________________________________________________ AGE: ___________ DOB: ______________________ RELATIONSHIP TO PROPOSED GUARDIAN(S) ________________________________________________________________ IS THIS CHILD LIVING WITH YOU, THE PROPOSED GUARDIAN(S), NOW? YES NO IF YOU ANSWERED YES, PLEASE STAT HOW AND WHEN THEY STARTED LIVING WITH YOU: __________________________________________________________________________________________________________

SCHOOL: ____________________________________________________________ PHONE: () _____________________ CHILDCARE: _____________________________ PHONE: () ___________________ DAYS/TIMES: ________________ DOCTOR: _____________________________________ PHONE: (______) _____________________ DOES THE CHILD HAVE ANY MEDICAL, DEVELOPMENTAL OR MENTAL HEALTH ISSUES? YES NO IF YOU ANSWERED YES, BRIEFLY STAT WHAT THE ISSUES ARE: _________________________________________________________________________________________________________

Mandatory Form GUARDIANSHIP QUESTIONNAIRE Page __ of __VN042 (Rev. 07/24) CONFIDENTIAL

VN042 CHILD(REN)’S NAME(S): CASE NUMBER:

DOES THIS CHILD HAVE AN IEP OR 504 EDUCATION PLAN WITH THEIR SCHOOL? YES NO

3. NAME: _____________________________________________________ AGE: ___________ DOB: ________________________ RELATIONSHIP TO PROPOSED GUARDIAN(S) ________________________________________________________________ IS THIS CHILD LIVING WITH YOU, THE PROPOSED GUARDIAN(S), NOW? YES NO IF YOU ANSWERED YES, PLEASE STAT HOW AND WHEN THEY STARTED LIVING WITH YOU: __________________________________________________________________________________________________________

CHILDCARE: _____________________________ PHONE: (______) ___________________ DAYS/TIMES: ________________

DOCTOR: _____________________________________ PHONE: (______) _____________________ DOES THE CHILD HAVE ANY MEDICAL, DEVELOPMENTAL OR MENTAL HEALTH ISSUES? YES NO IF YOU ANSWERED YES, BRIEFLY STAT WHAT THE ISSUES ARE: _________________________________________________________________________________________________________ DOES THIS CHILD HAVE AN IEP OR 504 EDUCATION PLAN WITH THEIR SCHOOL? YES NO

4. NAME: _______________________________________________________ AGE: ___________ DOB: ______________________ RELATIONSHIP TO PROPOSED GUARDIAN(S) ________________________________________________________________ IS THIS CHILD LIVING WITH YOU, THE PROPOSED GUARDIAN(S), NOW? YES NO IF YOU ANSWERED YES, PLEASE STAT HOW AND WHEN THEY STARTED LIVING WITH YOU: __________________________________________________________________________________________________________

SCHOOL: ____________________________________________________________ PHONE: () _____________________ CHILDCARE: _____________________________ PHONE: () __________________ DAYS/TIMES: _________________ DOCTOR: _____________________________________ PHONE: (______) _____________________ DOES THE CHILD HAVE ANY MEDICAL, DEVELOPMENTAL OR MENTAL HEALTH ISSUES? YES NO IF YOU ANSWERED YES, BRIEFLY STAT WHAT THE ISSUES ARE: _________________________________________________________________________________________________________ DOES THIS CHILD HAVE AN IEP OR 504 EDUCATION PLAN WITH THEIR SCHOOL? YES NO

SECTION VI – FUTURE PLANS

HOW LONG WILL GUARDIANSHIP BE NECESSARY? _____________________________________________________________

Mandatory Form GUARDIANSHIP QUESTIONNAIRE Page __ of __VN042 (Rev. 07/24) CONFIDENTIAL

VN042 CHILD(REN)’S NAME(S): CASE NUMBER:

DESCRIBE YOUR FUTURE PLANS FOR THE CHILD(REN) (school, extracurricular activities, social/emotional support, family relationships, etc.):

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SECTION VII – ESTATE

PLEASE INDICATE THE SOURCE OF THE MONEY OR PROPERTY (i.e.- Inheritance, gift, etc.)(INCLUDE COPY OF WILL):

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MONEY VALUE ___________________________ PERSONAL PROPERTY VALUE _____________________________________ WHERE WILL MONIES BE PLACED AND HOW HANDLED? (i.e.- Blocked Bank Account or will Guardian(s) Post a Bond):

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DOES CHILD (REN) HAVE MONEY IN THEIR OWN ACCOUNT? YES NO OR HELD JOINTLY? YES NO INDICATE AMOUNT AND NAMES ON JOINT ACCOUNTS ________________________________________________________ IS MINOR(S)’S NAME ON DEED TO REAL PROPERTY, STOCKS, BONDS? YES NO VALUE _________________

SECTION VIII – PARENTS

MOTHER’S NAME: ________________________________________________ DATE OF BIRTH: __________________________ ADDRESS: __________________________________________________________________________________________________ PHONE: ( _____) ______________________ FATHER’S _______________________________________________________ DATE OF BIRTH: __________________________ ADDRESS: __________________________________________________________________________________________________ PHONE: ( _____) _______________________ DO YOU BELIEVE IT IS DETRIMENTAL TO THE CHILD FOR EITHER PARENT TO HAVE CUSTODY? YES NO IF YES, EXPLAIN:

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Mandatory Form GUARDIANSHIP QUESTIONNAIRE Page __ of __VN042 (Rev. 07/24) CONFIDENTIAL

VN042 CHILD(REN)’S NAME(S): CASE NUMBER:

SECTION IX – OBJECTIONS

DO ANY OF THE RELATIVES BELOW OBJECT TO THE GUARDIANSHIP?

MOTHER YES NO FATHER YES NO

MATERNAL GRANDFATHER YES NO PATERNAL GRANDFATHER YES NO

MATERNAL GRANDMOTHER YES NO PATERNAL GRANDMOTHER YES NO ADULT SIBLINGS YES NO YES NO

WHY? _________________________________________________________________________________________________________

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YOU MUST ATTACH A COPY OF CHILD(REN)’S BIRTH CERTIFICATE(S), CUSTODY ORDER,

DECLARATION OF A PERSON PRESENT AT BIRTH OR OTHER RECORD SHOWING THE DATE OF BIRTH SUCH AS SCHOOL RECORDS

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

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Date Proposed Guardian’s Signature

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Date Proposed Guardian’s Signature

Mandatory Form GUARDIANSHIP QUESTIONNAIRE Page __ of __VN042 (Rev. 07/24) CONFIDENTIAL