Guardianship Affidavit Questionnaire And Declaration {PR-18}

SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO PR-18 [Rev. 3/19] CONFIDENTIAL DOCUMENT Page 1 www.sanmateocourt.org Guardianship Declaration Confidential Return To: Probate Court Clerk222s Office 400 County Center, Redwood City, CA 94063 Name of Proposed Ward(s): Case Number: Proposed Guardian(s) Information FormPlease complete this entire form and return it to the Probate Court Clerk at the time of filing.Use additional sheets when necessary to answer questions.Social History of the Minor(s)Legal name of 1st minor (as on birth certificate): Name minor is known by: Date of Birth: Place of birth: Present age: Sex: M F Health Current health problems? Yes No If yes, please explain: Name of minor222s physician: Telephone: Date of minor222s last examination: Is minor in counseling? Yes No Counselor222s name: Telephone: School/Day Care Name of school/day care facility: Address: Telephone Teacher222s name: Grade level: Are there special educational needs? Yes No If yes, please explain: Are you guardian of any other children? Legal Custody Is the child subject to any legal custody orders? Yes No If yes, describe type of orders (guardianship, dissolution, paternity, adoption proceedings, hearing dates and county. Minor222s Income: Savings: Social History of the 2nd Minor Legal name of 2nd minor (as on birth certificate): Name minor is known by: Date of Birth: Place of birth: Present age: Sex: M F American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO PR-18 [Rev. 3/19] CONFIDENTIAL DOCUMENT Page 2 www.sanmateocourt.org Health Current health problems? Yes No If yes, please explain: Name of minor222s physician: Telephone: Date of minor222s last examination: Is minor in counseling? Yes No Counselor222s name: Telephone: School/Day Care Name of school/day care facility: Address: Telephone Teacher222s name: Grade level: Are there special educational needs? Yes No If yes, please explain: Are you guardian of any other children? Legal Custody Is the child subject to any legal custody orders? Yes No If yes, describe type of orders (guardianship, dissolution, paternity, adoption proceedings, hearing dates and county): Minor222s income: Savings: List additional minor(s) on separate sheet(s) and include the same information as requested above. Relationship of Proposed Ward(s) to Proposed Guardians How long have you known the proposed ward(s): Briefly explain the circumstances that led to this proceeding and why the proposed ward(s) should be in your home or care: How long do you expect to be the guardian of the proposed ward(s)? Social History of the Proposed Guardian(s) Legal name: AKA222s (aliases): Date of birth: Social Security #: Driver222s License #: Place of birth: Present age: Residence: (House No.) (Street) (City) (State) (Zip) Telephone number: Message/ cell phone: American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO PR-18 [Rev. 3/19] CONFIDENTIAL DOCUMENT Page 3 www.sanmateocourt.org Health Current health problems? Yes No If yes, please explain: Education Highest grade or educational level completed: List any additional training or education: Military Service Branch: Type/Date of Discharge: Employment Occupation Dates Employed: Employer: Telephone: Address: Can you be contacted at work? Yes No Contact Number: Financial Monthly income: Additional income: Number of dependents: Rent/mortgage payment: Other total monthly expenses (include child support payments): Are you planning on filing for AFDC? Yes No Are you planning on filing for Medi-Cal? Yes No Housing Rent Own Length of time in current residence? Number of bedrooms: Is residence a house or an apartment? Do you plan to remain in this location or are you looking for other accommodations? Explain: Accommodations for proposed ward: Marital History Number of previous marriages: Date and place of current marriage: Names of your children Birthdate(s) Drivers License: Address: Phone: Please provide the following information for other persons 16 years of age and above residing in the home: Names Birthdate(s) Drivers License: Relationship: American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO CONFIDENTIAL DOCUMENT Page 4 www.sanmateocourt.org Social History of the Present Spouse/Cohabitant Legal name: AKA222s (aliases): Date pf Birth: Place of Birth: Present age: SS#: Driver222s License #: State: Residence: (House No.) (Street) (City) (State) (Zip) Telephone number (day): Telephone number (evening): Health Current health problems? Yes No If yes, please explain: Education Highest grade or educational level completed: List any additional training or education: Military Service Branch: Type/Date of Discharge: Employment Occupation Dates Employed: Employer: Telephone: Address: Can spouse/cohabitant be contacted at work? Yes No Contact Number: Marital History Number of previous marriages: Names of Spouse222s /Cohabitant222s Children: Birthdate(s) Drivers License: Address: Phone: List persons who are familiar with the history of the minor222s parents: (Name & Relationship) (Street) (City) (State) (Zip) (Daytime Phone #) (Name & Relationship) (Street) (City) (State) (Zip) (Daytime Phone #) (Name & Relationship) (Street) (City) (State) (Zip) (Daytime Phone #) Birth/Legal Parents The Court Investigator may attempt to contact the parents, if current information is needed. continued on next pagePR-18 [Rev. 3/19] American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO CONFIDENTIAL DOCUMENT Page 5 www.sanmateocourt.org Birth/Legal Father222s Name Date of birth: Residence: (House No.) (Street) (City) (State) (Zip) Telephone number: SS#: DL# Employer: Telephone: Does the minor(s) see the father? Yes No Explain: Has the father provided any financial support for the child(ren)? Yes No If yes, how much? Date of payments: Is the father in agreement with this proceeding? Yes No Birth/Legal Mother222s Name Date of birth: Residence: (House No.) (Street) (City) (State) (Zip) Telephone number: SS#: DL# Employer: Telephone: Does the minor(s) see the mother? Yes No Explain: Has the mother provided any financial support for the child(ren)? Yes No If yes, how much? Date of payments: Is the mother in agreement with this proceeding? Yes No I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct to the best of my knowledge. Dated: at: , California Signature: Print or type your name: Note: If another person filled out this document for you, that person must also sign the acknowledgment under penalty of perjury. Dated: at: , California Signature: Print or type your name:PR-18 [Rev. 3/19] You may be charged for the cost of this investigation pursuan t to Probate Code Section 1513.1 American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF CALIFORNIA - COUNTY OF SAN MATEO PR-18 [Rev. 3/19] CONFIDENTIAL DOCUMENT Page 6 www.sanmateocourt.org Release of Information - Consent Form (Please Print) I, , DOB: hereby give my consent , DOB: hereby give my consent , DOB: hereby give my consent to , Court Investigator of the Superior Court of San Mateo County, to obtain information from Children and Family Services regarding any records that agency may have pertaining to me. Signature Date Signature Date Signature Date Witness Date Case Name - Minor(s) Case Number: Court Hearing Date: American LegalNet, Inc. www.FormsWorkFlow.com