Investigation Questionnaire (For A Stepparent Or Domestic Partner Adoption) {FL-E-LP-647}

FOR COURT USE ONLY In the Superior Court of the State of California In and for the County of Sacramento INVESTIGATION QUESTIONNAIRE CASE NAME: CASE NUMBER: Instructions to Petitioner: In order to facilitate a stepparent (or domestic partner) adoption or termination of parental rights, you must complete this questionnaire and provide copies of the required documents as indicated to: SACRAMENTO COUNTY SUPERIOR COURT 3341 Power Inn Road, Family Law Sacramento, CA 95826 The questionnaire is important in introducing you and your situation to the investigator handling your case. Attach all additional documents as applicable to this questionnaire. The court will not file an incomplete packet or schedule a hearing date until all of the necessary forms are completed and submitted to the court. I. P E T I T I O N E R Your current name: Maiden name and/or any other names used: Name & telephone number of your attorney: Your current address (Street, City, State and ZIP): How long at this address? Home Telephone: ( ) Years Months Business Telephone: ( ) ) ( ) Driver's License No.: If no home or business telephone, give a contact number where the investigator can reach you: ( II. I D E N T I F Y I N G D A T A O F P E T I T I O N E R Social Security Number: Race: Eye Color: Age: Hair Color: Wgt: Date of Birth: Hgt: Place of Birth: Extent of schooling, H.S./College, etc.: Insurance (Life, Health, Car, etc.) specify: FL/E-LP-647 (adopted 6/10; rev'd 2/17) Mandatory Investigation Questionnaire Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com III. M A R I T A L H I S T O R Y O F P E T I T I O N E R (List all marriages) Time First Second Third Name of spouse (use maiden names) include present marriage Date of Marriage / / / / / / Date Separated / / / / / / Date & How Terminated Number of Children **Attach a certified copy of the current marriage license or Certificate of Registered Domestic Partnership** **If applicable, attach a certified copy of the final divorce judgment of each previous marriage** **If applicable, attach a certified copy of any orders changing your name** IV. C H I L D (List the child INVOLVED with this Court action) Name Date of Birth / / Living with Address Name of other parent Indian Ancestry? yes no Has the child ever been involved in any other court case? Yes No If so, what county ________________, case number _____________________. **Attach certified copy of the birth certificate** **If applicable, attach a certified copy of the Order of Adoption, if the minor has been previously adopted** **If applicable, attach a certified copy of the most recent court order awarding custody of the child to be adopted or an Order Terminating** Parental Rights or Order Declaring Minor Free from Parental Custody and Control **If applicable, attach a certified copy of any orders changing the child's name** V. C H I L D R E N (List all your other children NOT INVOLVED in the Court action) Name Date of Birth / / / / / / / / Living with Address Name of other parent Since the separation of the parents of the minor(s), whom have the child(ren) been living with? Also list dates: VI. H E A L T H O F C H I L D R E N (List each child in this case who has recently been under the care of a Doctor, or Psychiatrist, including family physician) Child Doctor Address Date / / / / / / / / Reason FL/E-LP-647 (adopted 6/10; rev'd 2/17) Mandatory Investigation Questionnaire Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Do any of the children presently have physical or mental problems? Yes No If "Yes", please explain: Plan of custody/visitation: Place of residence for self and children: Will children be placed under supervision of others? Yes Name of caretaker: Relationship to children No Address If "Yes", please complete below: Phone Number What period of time ( ) ( ) State the reasons why you feel the other parent should not have custody/visitation and be specific. Give examples and dates (attach additional sheet, if needed). VII. E M P L O Y M E N T (Beginning with your present employment, list employment for the last 5 years) Name of Employer Address of Employer Type of Job Date Begun / / / / / / / / Date Left / / / / / / / / Reason for Leaving Current working hours and days: MONTHLY INCOME From employment Own business Public Assistance (AFDC or Social Security Assistance) Child support Other sources TOTAL Does the petitioner pay child support? Yes If yes, is the amount in the arrears? Yes No No If yes, amount in arrears $_________ Gross $ $ $ $ $ $ Net $ $ $ $ $ $ FL/E-LP-647 (adopted 6/10; rev'd 2/17) Mandatory Investigation Questionnaire Page 3 of 6 American LegalNet, Inc. www.FormsWorkFlow.com VIII. M E D I C A L H I S T O R Y O F P E T I T I O N E R (If either parent or guardian have any physical disability or have received psychiatric treatment or counseling, please complete the section below) Name of Doctor & Address Name of Hospital & Address When Treated / / / / / / / / / / / / Nature of Illness IX. C R I M I N A L R E C O R D O F P E T I T I O N E R Does petitioner have a criminal record? Yes No If "Yes", please give details: Is petitioner on Probation or Parole? Yes No If "Yes", please give name of Probation Officer or Parole Agent: ______________________________________________ Area office: ( ) Phone number: ( No ) Does the petitioner have any criminal actions pending: Yes If "Yes", please explain: FL/E-LP-647 (adopted 6/10; rev'd 2/17) Mandatory Investigation Questionnaire Page 4 of 6 American LegalNet, Inc. www.FormsWorkFlow.com X. N A T U R A L F A T H E R Name of natural father: Address: Date of Birth: Occupation: Has he consented to Adoption: Yes No / / Place of Birth: Employer: Date of last support: Date of last contact with child: Race: Date of last contact with any other relative: ** If applicable, attach a certified copy of the death certificate, proof of parental rights being terminated, or orders changing father's name ** MARITAL HISTORY OF NATURAL FATHER (List all marriages) Time First Second Third Name of spouse (use maiden names) include present marriage Date of Marriage / / / / / / Date Separated / / / / / / Date & How Terminated Number of Children Is the child a result of a donorship? Yes No Is yes, attach proof of donorship. FL/E-LP-647 (adopted 6/10) Mandatory Adoption Questionnaire Page 5 of 6 American LegalNet, Inc. www.FormsWorkFlow.com XI. NATURAL MOTHER Name of natural mother: Address: Date of Birth: Occupation: Has she consented to Adoption: Yes