Free PR-2 - California

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SONOMA
Probate Division 600 Administration Drive, Room 107-J Santa Rosa, CA 95403-2878
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IN THE MATTER OF THE PROPOSED GUARDIANSHIP OF: Court No.: __________________ Hearing Date: _______________ _______________________________Minor(s)

REPORT OF PROPOSED GUARDIAN Pursuant to local court policy, this report MUST be fully completed by all persons petitioning to be appointed as guardian for a minor. The information in the report will be used by the Court for the following purposes: 1. To determine whether an investigation should be performed in accordance with Section 1513 of the Probate Code; and 2. To determine whether Sonoma County should be reimbursed, in whole or in part, for the expense of an investigation. The original of this report must be filed with the Petition for Appointment of Guardian. The Superior Court Clerk=s Office will not accept petitions not accompanied by this report. After filing the original, an endorsed copy of this report, together with a copy of the petition and ALL attachments, must be delivered within five days to the Family Court Services at the following address: Family Court Services 475 Aviation Blvd., Ste 110 Santa Rosa, CA 95403 If you are asking to be appointed guardian of more than one minor, please provide the information requested in paragraph 1 for each minor by attaching separate sheets of paper.

PR-2 [Rev. 1/1/07]

REPORT OF PROPOSED GUARDIAN

Page 1 of 6

I. A. B.

MINOR: Birth name: ______________________________ Age: ______ Date of Birth: _____________ With whom has minor lived from birth to present date: 19___ to 19___ with ____________________________________________________________ 19___ to 19___ with ____________________________________________________________ 19___ to 19___ with ____________________________________________________________ Who presently has legal custody of the minor? _____________________________________________________________________________ Name under which minor is presently enrolled in school: _____________________________________________________________________________ School in which minor is presently enrolled: _____________________________________________________________________________ Does the minor have a history of attendance, achievement or adjustment problems in school? Yes No Does the minor have a history of involvement with the police, the Juvenile Court, the Probation Department, the Social Service Department or the Child Protective Service? Yes No Does the minor have any special physical, medical, developmental, educational or psychological needs requiring restricted activity, ongoing medical supervision, special educational services or professional counseling? Yes No Has the minor ever been a patient in an institution operated by a State Department of Mental Health or a state Department of Developmental Services? Yes No Are there currently pending any other proceedings affecting the Minor=s custody such as adoption, Juvenile court or Dissolution of Marriage proceedings? Yes No Has the minor ever been married? Yes No If you answered yes to any of the above, please elaborate:

C.

D.

E.

F. G.

H.

I.

J.

K. L.

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REPORT OF PROPOSED GUARDIAN

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M. How does the minor feel about your appointment as guardian?

II. A.

MINOR=S BIRTH PARENTS: Father (if unknown, a certified copy of the minor=s birth certificate must be attached to this Report). 1. Name __________________________________________ DOB ____________________ 2. Address ________________________________________ Phone ____________________ 3. Occupation _________________________ Employer ______________________________ 4. Does the father have a history of ongoing contact and involvement with the minor? Yes No 5. Is the father contributing to the minor=s support? Yes No 6. Does the father agree with your appointment as guardian? Yes No Mother 1. Name _________________________________________ DOB ______________________ 2. Address ________________________________________ Phone ____________________ 3. Occupation ________________________ Employer _______________________________ 4. Does the mother have a history of ongoing contact and involvement with the minor? Yes No 5. Is the mother contributing to the minor=s support? Yes No 6. Does the mother agree with your appointment as guardian? Yes No

B.

III.

PROPOSED GUARDIANS:

A. Name ___________________________ Age ___________ Date of Birth ________________ B. C. Social Security # __________________ Driver=s License # ___________________________ Address ____________________________________________________________________

D. Telephone: 1. Home ________________________ 2. Work _________________________
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Continued PROPOSED GUARDIANS: E. F. Occupation ___________________________ Employer _____________________________ Children: 1. Name __________________________ Age ______ Address ______________________ 2. Name __________________________ Age ______ Address ______________________ 3. Name ___________________________ Age ______ Address ______________________ G. Identify all people residing in your home (including date of birth if 18 years and over): 1. Name __________________________ Age ______ Relation_______________________ Date of Birth ____________ Driver=s License # _______________ SS# ______________ 2. Name ___________________________ Age ______ Relation ______________________ Date of Birth ___________ Driver=s License # ________________ SS# ______________ 3. Name ____________________________ Age ______ Relation _____________________ Date of Birth ___________ Driver=s License # ________________ SS# ______________ H. I. Your relation to the minor _____________________________________________________

Do you anticipate being able to provide a stable and permanent home for the minor until the minor becomes 18 years of age? Yes No J. Have you filed a Petition for Adoption of the Minor? Yes No K. Is your home licensed as a foster family home? Yes No L. Have you ever been arrested? Yes No M. Have you or any member of your family ever been referred to a law enforcement agency or a child protective service agency because of suspected harm to or neglect of a minor? Yes No N. What is your gross monthly income from all sources? O. P. If appointed guardian, would you need financial assistance to provide for the minor=s needs? Yes No Will you be requesting payment for your services as guardian? Yes No

PR-2 [Rev. 1/1/07]

REPORT OF PROPOSED GUARDIAN

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Q.

R.

If the costs associated with an investigation did not exceed $450.00, would you have the ability to pay for the investigation? Yes No Have you ever served as a guardian, conservator, executor, personal representative or trustee? Yes No 1. If your answer is YES list the dates and county of your service and the court number of the proceeding: _______________________ _________________________ ________________________
Date County Case number

_______________________ _________________________ ________________________
Date County Case number

IV. A.

MINOR=S PROPERTY AND INCOME: Does the minor possess money or property other than clothes, toys and common personal items? Yes No 1. If your answer is YES, what is the approximate value of the minor=s property? $_________________

B.

Is the minor expected to receive in the future an inheritance from a deceased relative, proceeds from an insurance policy, a settlement from a civil action, or funds from any other source? Yes No 1. If your answer is YES, what is the value of the money the minor is expected to receive? $_________________

C.

Is the minor entitled to receive benefits from the Veterans or Social Security Administration? Yes No 1. If your answer is YES, what amount per month is the minor entitled to receive? $_________________

D.

To the best of your knowledge, does any person or entity responsible for the minor=s support, including the minor=s parents, have the financial ability to pay the costs associated with an investigation if these costs do not exceed $450.00? Yes No 1. If your answer is YES, who has the ability to pay for the investigation? _______________________________________________________________________

PR-2 [Rev. 1/1/07]

REPORT OF PROPOSED GUARDIAN

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V.

EXPLANATIONS: A. Please briefly explain the reason(s) you believe a guardianship is necessary or convenient:

B. Use this space to provide any additional information or comments you feel the Courts should have:

Additional Information:

VI.

VERIFICATION: A. I declare under penalty of perjury that the foregoing is true and correct. B. This report and verification were executed on (date)_________________________ 20_____ at (City,State) __________________________________________________________.

_______________________________________
Signature

________________________________________
Signature

PR-2 [Rev. 1/1/07]

REPORT OF PROPOSED GUARDIAN

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