CONFIDENTIAL SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO REFERRAL FOR CII/CARPOS/ICMS REPORT (GUARDIANSHIP/CONSERVATORSHIP) Form A1 This form is required with all Guardianship/Conservatorship SB-13548 (Rev. 01/18/13) Case Number Ex Parte Hearing Date Department This Section to be Completed by Filing Party Petitioner Name: Male Female Petitioner Former Name: Petitioner AKAs, if any: Petitioner Date of Birth: Petitioner SSN: Second Petitioner Name : Male Female Second Petitioner Former Name: Second Petitioner AKAs, if any: Second Peti tioner Date of Birth: Second Petitioner SSN: Other Member of Household 18 Years Old & Older: M ALE F EMALE N AME : Date of Birth: SSN: Other Member of Household 18 Years Old & Older: M ALE F EMALE N AME : Date of Birth: SSN: Other Member of Household 18 Yea rs Old & Older: M ALE F EMALE N AME : Date of Birth: SSN: Name of Minor s Natural Mother: Date of Birth: SSN: Name of Minor s Natural Father: Date of Birth: SSN: COURT ORDER: This matter is referred to Family Law Processing for a CARPOS (CLETS) history report and a Criminal History Inquiry (CII) pursuant to Family Code 6306 and/or California Rule of Court 5.445. This matter is referred to Family Law Processing for a search of the Superior Court of California, County of San Bernardino Integrated Case Management System for a history report regarding existing custody and visitation orders pursuant to CRC 5.445. American LegalNet, Inc. www.FormsWorkFlow.com