SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE PALM SPRINGS 3255 E. Tahquitz Canyon Wy., Palm Springs, CA 92262 RIVERSIDE 4050 Main St., Riverside, CA 925 01 TEMECULA 41002 County Center Dr., #100, Temecula, CA 92591 RI - PR 095 ATTORNEY OR PARTY WITHOUT ATTORNEY ( Name, State Bar Number and Address) FOR COURT USE ONLY (CONFIDENTIAL) TELEPHONE NO.: FAX NO. (Optional): E - MAIL ADDRESS (Optional): ATTORNEY FOR (Name ): IN THE MATTER OF: CASE NUMBER: SOCIAL HISTORY OF MINOR Note to Petitioner: One form must be completed for each child. 1. AKA: 2. Primary Language: Needs an In terpreter? 3. How did this child come into your care? 4. Who cares for children if the guardian and/or spouse are both employed? 5. Baby sitter or Childcare Facility (include name, address and phone number): 6. Medical/Developmental/Psychological Problems List name and address of therapist if applicable: 7. What plans, if any have been made for visitation of parents and grandparents? Page 1 of 2 Adopted for Mandatory Use Riverside Superior Court Form RI - PR 095 [Rev. 01/01/19 ] SOCIAL HISTORY OF MINOR Probate Code 1513 riverside.courts.ca.gov/localfrms /localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com IN THE MATTER OF: CASE NUMBER: 8. Does the child receive any income from child support? No Yes What amount $ 9. Does the child receive income from any other source? N o Yes What source(s) and what amount(s)? 10. Name Date of Birth Telephone Email 11. Siblings of this child: Name Date of Birth I d eclare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (PRINT NAME) (SIGNATURE) Page 2 of 2 Adopted for Optional Use Riverside Superior Court Form RI - PR 095 [Rev. 01/01/19 ] SOCIAL HISTORY OF MINOR Probate Code 1513 riverside.courts.ca.gov/localfrms/localfrms .shtml American LegalNet, Inc. www.FormsWorkFlow.com