ATTACHMENT PB-4014
PB-4014 REV 3/12/2020 AUTHORIZATION FOR RELEASE OF INFORMATION Page 1 of 1
For Mandatory Use
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address): TELEPHONE NUMBER:
ATTORNEY FOR (Name): Self-Represented
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA
COURT ADDRESS:
PHONE NUMBER:
FAX NUMBER:
BRANCH NAME:
191 North First Street, San José, California 95113
(408) 882-2651
(408) 882-2693
Downtown Courthouse – Probate Division
In the Matter of the Guardianship of:
AUTHORIZATION FOR RELEASE OF INFORMATION
Probate Code Section 1513 requires that a probate court investigator conduct interviews and write a
report and recommendation to the Court concerning the appropriateness of establishing a guardianship
for the above-named children. In order to assist in the gathering of pertinent information,
I/we, /
specifically authorize the release of my/our school records, counseling records, probation records, public
and private social service records, summaries of medical and psychological records, and records from
any private or public agency which would assist in determination of our petition for guardianship.
Dated:
Dated:
Original to: Probate Court Investigator
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