(local form) FOR COURT USE ONLY (RECEIVED ON): In the Superior Court of the State of California In and for the County of Kings ADOPTION WITNESS QUESTIONNAIRE (for a Stepparent or Domestic Partner Adoption) CASE NUMBER: Name and telephone number of the individual for whom you are completing the questionnaire: Name: Telephone: (_____)_______________ Instructions on completing this form: In order to begin the investigation ordered by the Court, please complete this questionnaire for the petitioner who is requesting the adoption. The petitioner will submit this form, along with the investigation packet to: KINGS COUNTY SUPERIOR COURT 1426 South Drive Hanford, CA 93230 Attention: Adoption Clerk As you answer each question below, please keep in mind that it is the responsibility of the Court to safeguard the welfare and future development of the children in this family. You can help the Court in meeting this responsibility by being objective and confining your statements to observations which you have personally made. Answer each question as completely as possible using additional paper if needed. The investigator may contact you personally to discuss your statement with you. Your Name: Address: (City, State and Zip Code) Home Telephone: ( ) Work Telephone: ( ) ext. What is your relationship to the person (petitioner) named above (relative, friend, coworker, etc.)? How long have you known this person? How often do you have contact with them? Date you last had contact with them: How long have you known the child(ren) in this case? How often do you have contact with them? Date you last had contact with them: Do you know the natural parent? Yes, if yes, how long have you known them? No Adoption Witness Questionnaire (Stepparent or DP cases) Last revised on: 05-05-08 Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com PHYSICAL ENVIRONMENT If you have been in the home of the individual for whom you are a witness, describe the home including housekeeping standards, who prepares meals, etc.? CARE OF THE CHILDREN Describe how the individual for whom you are a witness treats, or cares for, the children (cleanliness, clothing, discipline, supervision). What is the nature of the relationship between the individual and the children from your observation? Have you ever witnessed physical or emotional abuse of the children by either parent (If so, please explain and give approximate dates)? CHILDREN State your personal observations of each child, including any physical or emotional problems known to you. Have the children expressed their feelings about this matter to you? Adoption Witness Questionnaire (Stepparent or DP cases) Last revised on: 05-05-08 Page 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com PARENTS To your knowledge, does the individual for whom you are a witness have problems in any of the following areas: Abuse of alcohol: No Yes Abuse of drugs (any): No Yes Criminal involvement: No Yes If you have answered “Yes” to any of the above, please explain. ADDITIONAL COMMENTS DATE: / / Adoption Witness Questionnaire (Stepparent or DP cases) _______________________________ (Signature) Last revised on: 05-05-08 Page 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com