Family Court Services (FCS) Questionnaire Regarding Application For Permission For Minor(s) {FCS-067}

SDSC FCS-067 (New 12/18) Family Court Services (FCS) Questionnaire Regarding Page 1 of 4 Mandatory Form Application for Permission for Minor(s) to Marry or Establish Domestic Partnership SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO Each party seeking marriage permission must separately complete this questionnaire and submitI. PARTIES ON APPLICATION FOR PERMISSION FOR MINOR(S) TO MARRY OR ESTABLISH DOMESTIC PARTNERSHIP Party 1. Full Legal Name: AKA Address: Street Apt. City State Zip Code Telephone Numbers: Home ( ) Work ( ) Last Four Digits of Social Security Number: xxx-xx Birth Date: // Place of Birth: Driver License Number: State: Currently Valid: Yes No Party 2. Full Legal Name: AKA or Maiden Name: Address: Street Apt. City State Zip Code Telephone Numbers: Home ( ) Work ( ) Last Four Digits of Social Security Number: xxx-xx Birth Date: // Place of Birth: Driver License Number: State: Currently Valid: Yes No Month and Year Parties Met: Date Planned for Marriage or Domestic Partnership: Has the decision to marry or establish a domestic partnership been made of your own free will? Yes No If no, please explain: Describe reason for minor marriage/domestic partnership permission request: Complete information below on your child(ren) or Not Applicable Party with First Middle Last Name Date of Birth Place of Birth whom residing 1. 2. 3. FAMILY COURT SERVICES (FCS) QUESTIONNAIRE REGARDING APPLICATION FOR PERMISSION FOR MINOR(S) TO MARRY OR ESTABLISH DOMESTIC PARTNERSHIP FOR COURT USE ONLY Case Name FCS Date Time Case No. Language Interpretation Request for FCS Appointment Yes No If yes, specify language American LegalNet, Inc. www.FormsWorkFlow.com SDSC FCS-067 (New 12/18) Family Court Services (FCS) Questionnaire Regarding Page 2 of 4 Mandatory Form Application for Permission for Minor(s) to Marry or Establish Domestic Partnership Section II to be completed if party is a minor. If party completing form is over age 18, proceed to Section III. II. PARENT(S)/LEGAL GUARDIAN(S) OF MINOR(S): (Full legal names) If one of the natural parents has died, please mark 223deceased224 for that person222s address and add the date of death, if known. 1. Full Legal Name: AKA or Maiden Name: Address: Street Apt. City State Zip Code Telephone Numbers: Home ( ) Work ( ) Last Four Digits of Social Security Number: xxx-xx Birth Date: // Place of Birth: Relationship to Minor Party: Mother Father Legal Guardian Other: Mark box below to indicate this parent/guardian222s attitude about your proposed marriage/domestic partnership: Supportive Neutral Strongly Opposed Attitude Unknown 2. Full Legal Name: AKA or Maiden Name: Address: Street Apt. City State Zip Code Telephone Numbers: Home ( ) Work ( ) Last Four Digits of Social Security Number: xxx-xx Birth Date: // Place of Birth: Relationship to Minor Party: Mother Father Legal Guardian Other: Mark box below to indicate this parent/guardian222s attitude about your proposed marriage/domestic partnership: Supportive Neutral Strongly Opposed Attitude Unknown 3. Full Legal Name: AKA or Maiden Name: Address: Street Apt. City State Zip Code Telephone Numbers: Home ( ) Work ( ) Last Four Digits of Social Security Number: xxx-xx Birth Date: // Place of Birth: Relationship to Minor Party: Mother Father Legal Guardian Other: Mark box below to indicate this parent/guardian222s attitude about your proposed marriage/domestic partnership: Supportive Neutral Strongly Opposed Attitude Unknown 4. Full Legal Name: AKA or Maiden Name: Address: Street Apt. City State Zip Code Telephone Numbers: Home ( ) Work ( ) Last Four Digits of Social Security Number: xxx-xx Birth Date: // Place of Birth: Relationship to Minor Party: Mother Father Legal Guardian Other: Mark box below to indicate this parent/guardian222s attitude about your proposed marriage/domestic partnership: Supportive Neutral Strongly Opposed Attitude Unknown Attorney for: or Not Applicable Name of Party Attorney Name: Tel. No.: () Address: Street Ste. City State Zip Code American LegalNet, Inc. www.FormsWorkFlow.com SDSC FCS-067 (New 12/18) Family Court Services (FCS) Questionnaire Regarding Page 3 of 4 Mandatory Form Application for Permission for Minor(s) to Marry or Establish Domestic Partnership III. LAW ENFORCEMENT AND CHILD WELFARE INFORMATION: Have charges ever been filed against you for crimes other than minor traffic citations? Yes No If yes, please explain: Charge City/State Date 1) 2) 3) Are you on parole or probation? Yes No If yes, has written approval from officer been obtained? Yes No Parole or Probation Officer222s Name: Tel. No.: ( ) Are there allegations of verbal intimidation or threats between you and prospective spouse/partner? Yes No Has there been physical violence between you and prospective spouse/partner? Yes No If yes, how long ago? 0 226 6 mos. 6 mos. 226 1 yr. 1 yr. or more Has law enforcement been involved? Yes No Provide details: Have you or anyone living in your home ever been accused of or been a victim of child abuse or child molestation? Yes No If yes, please explain: Are you a ward or dependent child of Juvenile Court? Yes No IV. YOUR EDUCATION: Highest Grade Completed: Graduated High School Yes No Year: License(s) or Credential(s) Received: College Degree(s) Received: V. YOUR EMPLOYMENT: Employer: Capacity/Job Title: Length of Employment: Salary: Supervisor222s Name, Address and Telephone Number: VI. YOUR HEALTH: Name of your health insurance plan: Are you taking any medication? Yes No If yes, what kind and for what reason(s)? Are you pregnant? Yes No Not Applicable Describe any special health concerns: Have you ever had any problem with the following? Alcohol: Yes No Drugs: Yes No Mental/Emotional Problems: Yes No If yes, what is your current condition regarding this problem? (Bring proof of treatment to interview) American LegalNet, Inc. www.FormsWorkFlow.com SDSC FCS-067 (New 12/18) Family Court Services (FCS) Questionnaire Regarding Page 4 of 4 Mandatory Form Application for Permission for Minor(s) to Marry or Establish Domestic Partnership VII. HOUSING AND FINANCES: Residence: The home you and your prospective spouse/domestic partner will live in is: owned rented Monthly Cost: $ Expenses paid by: Number of Bedrooms: Number of Bathrooms: Approximate Size: sq. ft. List other parties living in your household after the marriage/domestic partnership: Name Birth Date Relationship Supportive of Marriage Yes No Unknown Yes No Unknown Yes No Unknown Yes No Unkn own Yes No Unknown Income: List source(s) of household income and amount(s). Income Source Amount 1. 2. 3. Other Assets: List your other major assets or real property such as car, bank accounts, house. Asset Value 1. 2. 3. Debts: List your debts and amounts owed. Money Owed to: Amount 1. 2. 3. I declare under penalty of perjury under the laws of the State of California that all of the information I have submitted in this FCS Questionnaire is true and correct. Date: Type or print name Signature American LegalNet, Inc. www.FormsWorkFlow.com