GUARDIAN SHIP OF (NAME): CASE NUMBER: Form Adopted for OPT IONAL USE Superior Court of Santa Cruz County SUP CV 1077 11 / 02 / 18 DECLARATION IN SUPPORT OF GUARDIANSHIP - ATTACHMENT Page 1 of 1 ATTACHMENT (Number): I am the . I was born on . (Relationship to minor) (Month/Day/Year) The current state of my health is (please describe below): Continued on attached page The specific reason the parents are unable to care for the minor is (please describe below): Please explain below: Continued on attached page Check the box that best Does the minor have special emotional, psychological, educational, or personal needs? No Yes If yes, pl ease list the needs and how you are able to provide for them ( please describe below): Will the minor have his/her own room? Yes No (if No, please list who he/she will be sharing with): Full Legal Name: Relation. to Minor (if any): Date of Birth: Full Legal Name: Relation. to Minor (if any): Date of Birth: I de clare under penalty of perjury under California State law that the information in this form is tr ue and correct, which means if I /we lie on this form I /we am guilty of a crime. Date : (Petitioner) Pri nt Name Here (Petitioner) Sign Name Here 1 2 3 4 6 5 Mother is currently incarcerated, has passed away, is not mentally stable, is not financially stable, wants me to have the child, Other : Father is currently incarcerated, has passed away, is not mentally stable, is not financially stable, wants me to have the child, Other: Page of (add pages as required) American LegalNet, Inc. www.FormsWorkFlow.com