1 FCS-303-2016-M Mandatory Form July 2016 Name: address: Telephone #: ( ) Attorney : SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF TULARE Guardianship of: ) ) ) (Minor(s) last name) ) ) GUARDIANSHIP QUESTIONNAIRE ) (Case number) ) ) Because you may be making medical, educational, financial, and other life decisions for the Minor(s) (also may be referred to as Ward(s)), the Court, prior to granting Guardianship powers, would like to determine the stability, experience, and decision-making ability of the proposed Guardian(s). If you have questions, feel free to call the 0-5000. CURRENT NAME(S) OF MINORS: DOB: S.S. # AGE: ADDRESS: Provide the names of all proposed Minors who have Native American Ancestry: NAME(S) OF PROPOSED GUARDIAN(S): (Mandatory for each proposed Guardian) Name: Name: Address: Address: Home phone:Work: Home phone:Work: Relationship to Minor: Relationship to Minor: DOB:Age: DOB:Age: SS#: CADL#: SS#:CADL#: Expiration: Expiration: Sex: M F Height:Weight: Sex: M F Height:Weight: Eye color:Hair color: Eye color: Hair color: Other names used: Other names used: For Court Use Only: American LegalNet, Inc. www.FormsWorkFlow.com 2 FCS-303-2016-M Mandatory Form July 2016 MINOR #1: How long at current placement? Current School: Grade: Teacher: (Name) (Name) Days/Hours in school: Method of transportation: rides bus walks rides bike other After school programs/activities: Days/Hours attending after school program: Name of the doctor(s) who provide medical care for the Minor: (Include specialists) Date of last doctor visit: List all prescription and over-the-counter medications: Name of the dentist who provides dental care for the Minor: Name of the optometrist/ophthalmologist who provides eye care for the Minor: Name of the psychiatrist/psychologist/counselor: School days Weekends/Holidays NOTE: Please provide the current and prior year school attendance records and grade reports. (Example: 2003-2004 and 2004-2005). If there are more than three Minors, please copy this page and complete the information for each additional Minor. American LegalNet, Inc. www.FormsWorkFlow.com 3 FCS-303-2016-M Mandatory Form July 2016 MINOR #2: How long at current placement? Current School: Grade: Teacher: (Name) (Name) Days/Hours in school: Method of transportation: rides bus walks rides bike other After school programs/activities: After Days/Hours attending after school program: Name of the doctor(s) who provide medical care for the Minor: (Include specialists) List all prescription and over-the-counter medications: Name of the dentist who provides dental care for the Minor: Name of the optometrist/ophthalmologist who provides eye care for the Minor: Name of the psychiatrist/psychologist/counselor: Ch School days Weekends/Holidays NOTE: Please provide the current and prior year school attendance records and grade reports. (Example: 2003-2004 and 2004-2005). If there are more than three Minors, please copy this page and complete the information for each additional Minor. American LegalNet, Inc. www.FormsWorkFlow.com 4 FCS-303-2016-M Mandatory Form July 2016 MINOR #3: How long at current placement? Current School: Grade: Teacher: (Name) (Name) Days/Hours in school: Method of transportation: rides bus walks rides bike other After school programs/activities: Days/Hours attending after school program: Name of the doctor(s) who provide medical care for the Minor: (Include specialists) List all prescription and over-the-counter medications: Name of the dentist who provides dental care for the Minor: Name of the optometrist/ophthalmologist who provides eye care for the Minor: Name of the psychiatrist/psychologist/counselor: School days Weekends/Holidays NOTE: Please provide the current and prior year school attendance records and grade reports. (Example: 2003-2004 and 2004-2005). If there are more than three Minors, please copy this page and complete the information for each additional Minor. American LegalNet, Inc. www.FormsWorkFlow.com 5 FCS-303-2016-M Mandatory Form July 2016 : : Address: Address: Home phone: Home phone: Work phone: Work phone: Relationship to proposed Guardian: Relationship to proposed Guardian: DOB:SS#:CaDL: DOB:SS#:CaDL: Other names used: Other names used: HOUSEHOLD COMPOSITION OF PROPOSED GUARDIAN(S): (List all adults and children, related or unrelated, temporary or permanent) 1. Name: Other names used: DOB:Age:Sex:Place of birth:SS#: Height: Weight:Eye color: Hair color:CaDL: Name of school/place of employment: Address: Phone number: 2. Name: Other names used: DOB:Age:Sex:Place of birth:SS#: Height: Weight:Eye color: Hair color:CaDL: Name of school/place of employment: Address: Phone number: 3. Name: Other names used: DOB:Age:Sex:Place of birth:SS#: Height: Weight:Eye color: Hair color:CaDL: Name of school/place of employment: Address: Phone number: 4. Name: Other names used: DOB:Age:Sex:Place of birth:SS#: Height: Weight:Eye color: Hair color:CaDL: Name of school/place of employment: Address: Phone number: American LegalNet, Inc. www.FormsWorkFlow.com 6 FCS-303-2016-M Mandatory Form July 2016 PROPOSED GUARDIANS: (For each person petitioning the Court for guardianship and are not married or living together as domestic partners and not living in the same household, please copy pages 7 through 11 and provide the requested information.) Current marital status of the proposed Guardian: MarriedDivorcedRemarriedWidowedDomestic partners SeparatedCurrently living apart from spouse (please explain) List all previous marriages Name Date Married Date Separated Date Divorced List legal names of all children of proposed Guardian: Name DOB Age Place of Residence School Residence: Do you RentLeaseOwnyour residence? Years lived at this address Do you plan to remain in the residence? YesNo List residences for the three previous years Is your residence provided by your employer? Value of donated housing per month Is your residence a Mobile Home? Apartment? House? Other? If other, please explain Is your residence in a rural setting? Residential neighborhood? Mobile home park? Apartment complex? Other? If other, please explain Number of bedrooms How much is your rent/mortgage payment per month? To whom are payments made?(Name) (Address) If you are buying your home, provide the following information: Purchase price Current estimated market value Balance owed American LegalNet, Inc. www.FormsWorkFlow.com 7 FCS-303-2016-M Mandatory Form July 2016 Lending Institution(Name) (Address) What are your monthly utility bills? Gas Propane Electricity Telephone (home) Sewer/Water (cell/pager) Garbage (other) Have you ever been served with a Three Day Notice to Pay Rent or Quit Possession of Real Property pursuant to an oral or written agreement for the rental of residential real property? YesNo. If so, provide the date, name, address, and telephone numbers of the lessor or landlord. Income: Monthly income from employment Monthly income from commissions Do you have checking accounts? Yes No Please list the balance of each account separately. Do you have savings accounts? Yes No Please list the balance of each account separately. Monthly income from investments Name and address of investment broker Monthly income from other sources: Sources of income Amount Monthly income from public assistanceSocial Security (To whom each is paid) Disability payments Monthly/annual income from insurance settlement(s) Debts: Describe all long term debt other than mortgage listed above (include second, third, and fourth mortgages, vehicles, business property, rental property, etc.) American LegalNet, Inc. www.FormsWorkFlow.com 8 FCS-303-2016-M Mandatory Form July 2016 List all short term debt including each credit card debt, debt to private parties or family members, etc. (do not include bankruptcy debt) Have you have ever filed for bankruptcy? Yes No Please provide the following information for each time Type of petition Date filed Court in which filed Outcome Date debts discharged Have you ever been sued? Yes No Please explain Have you ever sued another person or entity, individually or on behalf of an entity? YesNo Please explain Employment: Length of employment