JV-079 (Rev. 03/21/2013)
AUTHORIZATION FOR COURT ACTIVITY
RECORD INFORMATION CHECK (CARI)
DOCKET NUMBER
Trial Court of Massachusetts
Juvenile Court Department
Guardianship of Minor
DIVISION
I hereby authorize the Juvenile Court to conduct a court activity record information check to
determine whether I have a criminal record. I understand the court activity record information
check is intended for use by the Court in conjunction with my petition for guardianship of the
above named minor. I further understand that the Court will not consider a petition for a
guardianship without conducting a court activity record information check of the guardian and the
co-guardian, if applicable. Therefore, the information below is willingly supplied by me, and my
signature indicates my permission for this record check to be completed.
Proposed Guardian's Name:
Current Address:
Social Security No:
Gender: Male Female Date of Birth:
Place of Birth:
Maiden Name (if applicable):
Other Names or Aliases used:
Mother's Name:
Father's Name:
DATE SIGNATURE OF PROPOSED GUARDIAN
NOTARIZATION
The above signed made oath before me on that this
authorization is his/her free act and deed.
Notary Public:
Print Name:
My Commission Expires:
FOR COURT USE ONLY
Results of CARI: CARI Check Conducted on:
Record (attached)
No Record
Sealed Record
DATE
SIGNATURE
