Partial Child Custody Investigation Questionnaire {FL-03}

SUPERIOR COURT OF CALIFORNIA COUNTY OF SUTTER 1175 Civic Center Boulevard, Yuba City, CA 95993 STEPHANIE M. HANSEL Court Executive Officer PARTIAL CHILD CUSTODY INVESTIGATION QUESTIONNAIRE This questionnaire is for the investigator's use only and will not be shared with any outside party. Please make sure it is complete and neat. Please immediately return this completed questionnaire to: Sutter County Superior Court 1175 Civic Center Boulevard Yuba City, CA 95993 Mediation is available throughout the investigation period. If you believe an agreement can be reached, please make use of these services. If you have any questions, please contact the investigators at (530) 822-3332. CHILD CUSTODY INVESTIGATION QUESTIONNAIRE- PARTIAL Superior Court of California, County of Sutter Optional Form (Revised Adopted 03/01/16) FL-03 Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF CALIFORNIA COUNTY OF SUTTER 1175 Civic Center Boulevard, Yuba City, CA 95993 STEPHANIE M. HANSEL Court Executive Officer AUTHORIZATION FOR RELEASE OF INFORMATION I, _______________________________________________, specifically authorize any public agency, private person, employer or past employer, medical doctor, psychologist, treating therapist or hospital possessing information about me or my children (listed below), including psychiatric information, confidential or otherwise, to release same (including copies) to the Superior Court through its duly appointed Court Investigator, such information to be used as the Court may deem fit and proper. A copy of this release shall be as valid as the original. This release shall remain in effect for one year from the date of my signature, unless otherwise revoked. Child's Full Name Date of Birth (Use back of this form for additional space, if needed) _________________________ Date _________________________ Date _________________________________ Authorizing Signature _________________________________ Court Investigator CHILD CUSTODY INVESTIGATION QUESTIONNAIRE- PARTIAL Superior Court of California, County of Sutter Optional Form (Revised Adopted 03/01/16) FL-03 Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Today's Date: _________________ Court Case Number: _______________________ Your Attorney's Name: _______________________________________________ Telephone Number: _____________________________________ You are the: Mother _____ Father _____ Your Full Name: _______________________________________________________ Other Names Used (Include Maiden Name): ________________________________ Current Address: ______________________________________________________ _____________________________________________________ Telephone Numbers: Home: __________________________________ Work: __________________________________ Cell or Message: _________________________ Fax: ___________________________________ Email Address: _____________________________________________ Date of Birth: ________________________________ Social Security Number: _______________________ Driver's License Number: ______________________ CHILD CUSTODY INVESTIGATION QUESTIONNAIRE- PARTIAL Superior Court of California, County of Sutter Optional Form (Revised Adopted 03/01/16) FL-03 Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com List All of the Children Involved in this Matter 1. Child's Full Name: ___________________________________________________ Date of Birth: ___________________________________ Age: ____ School and Grade: ___________________________________________________ 2. Child's Full Name: ___________________________________________________ Date of Birth: ___________________________________ Age: ____ School and Grade: ___________________________________________________ 3. Child's Full Name: ___________________________________________________ Date of Birth: ___________________________________ Age: ____ School and Grade: ___________________________________________________ 4. Child's Full Name: ___________________________________________________ Date of Birth: ___________________________________ Age: ____ School and Grade: ___________________________________________________ Please provide additional information that will aid the investigator in collecting the information requested by the court. For example, if the court requested that the investigator contact the child's therapist, provide the name and telephone number of the therapist or if the court requested that the investigator obtain the criminal history of an adult in your home, please provide that individual's complete name, date of birth, Social Security number and driver's license number: ___________________________________________________________________________________ ___________________________________________________________________________________ CHILD CUSTODY INVESTIGATION QUESTIONNAIRE- PARTIAL Superior Court of California, County of Sutter Optional Form (Revised Adopted 03/01/16) FL-03 Page 4 of 5 American LegalNet, Inc. www.FormsWorkFlow.com ___________________________________________________________________________________ ___________________________________________________________________________________ CHILD CUSTODY INVESTIGATION QUESTIONNAIRE- PARTIAL Superior Court of California, County of Sutter Optional Form (Revised Adopted 03/01/16) FL-03 Page 5 of 5 American LegalNet, Inc. www.FormsWorkFlow.com