Disclosure By Proposed Guardian(s) {GR005}

ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME, ADDRESS, PHONE) FOR COURT USE ONLY Attorney for: SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS Street Address: 800 11th Street, Modesto, CA 95354 Civil Clerk' Office: 1100 I Street, P.O. Box 1098, Modesto, CA 95353 IN THE GUARDIANSHIP OF: MINOR(S) DISCLOSURE BY PROPOSED GUARDIAN(S) Case No. 1. I am/We are the proposed guardian(s) in this proceeding. 2. I/We have made the parent(s) no promises about this guardianship, except as follows: (List promises given about visitation (if other than requested in item number 3), place of residence, religion, education, support money, and so forth). 3. I/We ask the court to order the following visitation plan for the minor(s): (As appropriate, list the frequency and duration, whether supervised and by whom, transportation arrangements, etc.) a. For father: b. For father's parents: c. For mother: d. For mother's parents: e. For the brothers and sisters of minor(s): 4. The child(ren) will live with the guardian(s), or (list name, relationship and address):___________________________________________________________________ __________________________________________________________________________ (continued on reverse) GR005 (Mandatory Form) Rev 06/11 American LegalNet, Inc. www.FormsWorkFlow.com 5. List persons who will provide non-licensed day care for the child(ren):__________________ __________________________________________________________________________ 6. List persons who live in the home full or part time and their ages:______________________ __________________________________________________________________________ 7. Each child will: have his/her own bedroom, or share a bedroom or other room with the following person: child____________________with _______________________________ child____________________with________________________________ 8. Each child will: have his/her own bed, or sleep on a sofa or share a bed with the following persons: child____________________with________________________________ child____________________with________________________________ 9. The child(ren) will attend the following school(s) (list child, his/her school and the distance from their proposed home):_____________________________________________________________________ __________________________________________________________________________ 10. I will support the child with: My income AFDC (Aid for Dependent Children) Social Security Voluntary support paid by the parent(s) (Explain) _________________________________ The child(ren)'s money (Explain) ______________________________________________ I/WE DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT. Date: _________________ _____________________________ PRINT NAME ______________________________ SIGNATURE _____________________________ PRINT NAME ______________________________ SIGNATURE GR005 (Mandatory Form) Rev 06/11 American LegalNet, Inc. www.FormsWorkFlow.com