CONFIDENTIAL FOR COURT USE ONLY ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): TELEPHONE NO.: FAX NO.: ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO MADGE BRADLEY BLDG., 1409 4TH AVE., SAN DIEGO, CA 92101-3105 NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92083-6645 GUARDIANSHIP OF: CASE NUMBER GUARDIANSHIP DISCLOSURE STATEMENT Ex Parte Application for Temporary Guardianship WARNING: DO NOT SIGN THIS FORM IF ANY OF THE STATEMENTS BELOW ARE INCORRECT, OR YOU WILL BE COMMITTING A CRIME PUNISHABLE BY A FINE, IMPRISONMENT, OR BOTH. Petitioner’ relationship to subject: s 1. Please state immediate necessity for appointment of a temporary guardian: 1A. Please state why parental custody would be detrimental to minor: 2. Have mother and/or father been notified of this hearing? How and when was Notice of ex parte given? Describe: Yes No 3. When was the last contact with the mother and/or father? Explain: 4. Has CPS been involved with minor? Caseworker What was involvement and when? Yes No Phone Number 5. Have there been any dependency hearings in Juvenile Court, custody proceedings in Family Court or any other guardianship proceeding? Yes No Explain, giving dates 6. Have you been assisted in the preparation of your paperwork by: Lawyer Program Other (please indicate) What fee, if any, was paid for service? attorney legal assistant Legal Aid Volunteer 7. Please state whereabouts of minor as of this date, and length of time at the location 8. If the proposed guardian is not a relative, is the proposed guardian serving as guardian for any other minor child to whom they are not related? Yes No I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Signature SDSC PR-87 (Rev. 2-03) GUARDIANSHIP DISCLOSURE STATEMENT American LegalNet, Inc. www.USCourtForms.com