Child Custody Investigation Questionnaire {FL-02}

SUPERIOR COURT OF CALIFORNIA COUNTY OF SUTTER 1175 Civic Center Boulevard, Yuba City, CA 95993 STEPHANIE M. HANSEL Court Executive Officer CHILD CUSTODY INVESTIGATION QUESTIONNAIRE This questionnaire will be attached to the Investigation Report for the Court's review. It is for the Court's use only and will not be shared with any outside party. Please make sure it is complete and neat. Please return this completed questionnaire to: Sutter County Superior Court 1175 Civic Center Boulevard Yuba City, CA 95993 by ____________ or within seven days. 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. Revised January 2016 CHILD CUSTODY INVESTIGATION QUESTIONNAIRE Superior Court of California, County of Sutter Optional Form (Revised Adopted 03/01/17) FL-02 Page 1 of 13 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 Sutter County Child Custody Investigation Questionnaire Page 1 Revised January 2016 CHILD CUSTODY INVESTIGATION QUESTIONNAIRE Superior Court of California, County of Sutter Optional Form (Revised Adopted 03/01/17) FL-02 Page 2 of 13 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: _____________________________________________ Social Security Number: _______________________________________ Driver's License Number: ______________________________________ Age: __________ Sex: M F Date of Birth: __________ Place of Birth: __________ Height: __________ Weight: __________ Eye Color: __________ Hair Color: __________ How Long Have You Lived In: The United States? ____________ California? ___________________ CHILD CUSTODY INVESTIGATION QUESTIONNAIRE Superior Court of California, County of Sutter Optional Form (Revised Adopted 03/01/17) FL-02 Page 3 of 13 American LegalNet, Inc. www.FormsWorkFlow.com Sutter County? _______________ Sutter County Child Custody Investigation Questionnaire Page 2 Revised January 2016 List All People Who Currently Reside In Your Home: Full Name (All Names Used) Date of Birth Relationship to You Driver's License and Social Security Number How Long Have You Lived At Your Current Address? _________________________ List All of Your Residences in the Last Five Years: Address Dates Reason for Moving Your High School: _________________________________________________________ Your Date of Graduation: (If not, why?): _______________________________________ CHILD CUSTODY INVESTIGATION QUESTIONNAIRE Superior Court of California, County of Sutter Optional Form (Revised Adopted 03/01/17) FL-02 Page 4 of 13 American LegalNet, Inc. www.FormsWorkFlow.com Your College or Trade School: _______________________________________________ Your Date of Graduation and Type of Degree: __________________________________ Sutter County Child Custody Investigation Questionnaire Page 3 Revised January 2016 List Your Last Three Employers, Beginning With Present: Name Address Position Date Started Date Left/Reason Current Days and Hours You Work: _______________________________________ Amount of Income Per Month: ___________________________________________ Your Source of Income If You Are Not Employed: ____________________________ List Any Childcare Your Child(ren) Will Attend During Your Parenting Time: Provider's Name Address Telephone Number Days and Times Your Military Service: Branch: ______________________________________ Rank: ________________________________________ CHILD CUSTODY INVESTIGATION QUESTIONNAIRE Superior Court of California, County of Sutter Optional Form (Revised Adopted 03/01/17) FL-02 Page 5 of 13 American LegalNet, Inc. www.FormsWorkFlow.com Discharge Date: _______________________________ Type of Discharge: _____________________________ Sutter County Child Custody Investigation Questionnaire Page 4 Revised January 2016 Your Current Spouse: __________________________________________________ Other Names Used (Include Maiden Name): _______________________________ Date and Place of Birth: _______________________________________________ Driver's License Number: ______________________________________________ Social Security Number: _______________________________________________ Date and Place of Marriage: ____________________________________________ Status of Present Marriage: ____________________________________________ Employer Name and Address: __________________________________________ Occupation: _________________________________________________________ Days and Hours of Work: ______________________________________________ List All of Your Children's Medical Doctors and Mental Health Counselors/Therapists: Provider's Name Telepho