Guardianship Petition—Child Information Attachment GC-210(CA) Case Number: Guardianship of (all children’s names): This child’s name: Fill out a separate copy of this form for each child for whom you want the court to appoint a guardian. This form is attached to the Petition, item 2 of form GC-210, or item 8 of form GC-210(P). The Petition asks for the appointment of a guardian of this child’s (specify): person estate person and estate 1 Tell the court about this child a. Child’s full legal name: Date of birth: First Middle Last Month/Day/Year b. Child’s current address: c. (Answer the questions in item c only if the Petition to which this form is attached asks for the appointment of a guardian of this child's person or this child's person and estate.) (1) Is this child a member of, or eligible for membership in, an Indian tribe recognized by the federal government? No Not sure Yes, (specify tribe): (If you checked “Yes” to item (1), this guardianship case is subject to the Indian Child Welfare Act (“ICWA”) (25 U.S.C. § 1901, et seq.). If you checked “Not sure” or “No” to item 1, answer item (2)). (2) Do you know or have reason to know (within the meaning of Prob. Code, § 1460.2, Welf. & Inst. Code, § 224.3, and rule 7.1015 of the Cal. Rules of Court), that this child may be an Indian child? No Yes (If you checked “Yes” to either item (1) or item (2), you must fill out a Notice of Child Custody Proceeding for Indian Child (Form ICWA-030) (“Notice”). Your attorney must serve copies of the Notice, together with copies of your petition and all attachments, including this form, on the child's parents; any Indian custodian (as defined in ICWA, at 25 U.S.C. § 1903, and Probate Code section 1449); any Indian tribe that may have a connection to the child; the Bureau of Indian Affairs; and possibly the U. S. Secretary of the Interior, by certified or registered U. S. Mail, return receipt requested. If you are not represented by an attorney in this case, the court will serve copies of these papers, but you must first fill out the original Notice and deliver it to the court. After service, the original Notice and all return receipts must be filed with the court. Service of the Notice is in addition to service of any other notices required in this case.) d. Is this child married? Yes No Never married If you checked “No,” was this child formerly Yes married but the marriage was dissolved or ended in divorce? No (The court cannot appoint a guardian of the person for a minor child who is married or whose marriage was dissolved or ended in divorce.) Yes No Unknown (If you checked "Yes," fill out below.) e. Is this child receiving public assistance? Type of Aid Monthly Benefit Type of Aid Monthly Benefit TANF (Temporary Asst. for Needy Families) $ Other (explain): $ Social Security $ Other (explain): $ Dept. Veterans Affairs Benefits $ f. Name and address of the person with legal custody of this child: Judicial Council of California www.courtinfo.ca.gov Revised January 1, 2008, Mandatory Form Probate Code, §§ 1449, 1459.5, 1510, Cal Rules of Court, rule 7.1015 Guardianship Petition—Child Information Attachment GC-210(CA), Page 1 of 4 (Probate—Guardianships and Conservatorships) American LegalNet, Inc. www.FormsWorkflow.com Case Number: Guardianship of (all children’s names): This child’s name: 1 Tell the court about this child (continued) g. (Check this box and fill out below if the person the child lives with is not the person with legal custody.) Name and address of the person this child lives with (has the care of the child): h. (Check this box if this child has been involved in an adoption, juvenile court, marriage dissolution (divorce), domestic relations, custody, or other similar court case.) Describe the court case below: Type of Case i. 2 Court District or County and State Case Number (if known) (Check this box if this child is in or on leave from an institution supervised by the California Department of Developmental Services or the California Department of Mental Health.) Write the name of the institution here: List the names and addresses of this child’s relatives and other persons shown below: Relationship Name Home Address (Street, City, State, Zip) Father Mother Grandfather (Father’s father) Grandmother (Father’s mother) Grandfather (Mother’s father) Grandmother (Mother’s mother) Brother/Sister Brother/Sister Brother/Sister Revised January 1, 2008 Guardianship Petition—Child Information Attachment (Probate—Guardianships and Conservatorships) GC-210(CA), Page 2 of 4 Case Number: Guardianship of (all children's names): This child’s name: 2 Names and addresses of this child’s relatives and other persons (continued): Relationship Name Home Address (Street, City, State, Zip) Brother/Sister Brother/Sister Check here if this child has additional brothers or sisters, including half-brothers and half-sisters, and list their names and addresses on a separate sheet of paper. Write “Form GC-210(CA),” the name of this child, and “Item 2:—Other Siblings” at the top of the paper and attach it to this form. Spouse (Guardianship of the estate only) Person nominated as guardian of this child (Other than a proposed guardian listed in 3 ) 3 Information about the proposed guardian: a. Name (name all proposed guardians if more than one): b. Relationship(s) to the child named in 1 (check all that apply): Relative (specify relationships of all proposed guardians to the child): Not a relative (explain interest in or connection to this child ): 4 Explain why appointing the person in 3 guardian would be best for this child: Check here if you need more space. Continue your explanation on a separate sheet of paper. Write “Form GC-210(CA),” the name of this child, and “Attachment 4:—Best Interest of Child” at the top of the paper and attach it to this form. Revised January 1, 2008 Guardianship Petition—Child Information Attachment (Probate—Guardianships and Conservatorships) GC-210(CA), Page 3 of 4 Case Number: Guardianship of (all children's names): This child’s name: 5 Do one or both of this child's parents agree that the person in 3 can be the child's guardian? a. Father: Yes No Not known at this time. b. Mother: Yes Not known at this time. No (You may file a filled-out Consent to Appointment of Guardian and Waiver of Notice (form GC-211, item 4) signed by the child’s parent or parents (or any adult relative listed in 2 ) who agree. The court may excuse you from having to give notice of the court hearing on your request for appointment of a guardian to a parent or other relative who signs that form.) 6 Suitability for guardianship of this child a. Does this child live with the person in 3 now? b. If the court approves the guardianship, will this child live with the person in 3 ? c. Does the person in 3 plan to adopt this child now? 7 Yes Yes Yes No No No Check this box if you (the petitioner) are not the person in 3 , and fill in below. Your relationship to this child: Relative (specify): Not a relative (explain your interest in or connection to this child): 8 Except as otherwise stated in this form, the statements made in the Petition to which this form is attached fully apply to this child. Revised January 1, 2008 Guardianship Petition—Child Information Attachment (Probate—Guardianships and Conservatorships) GC-210(CA), Page 4 of 4