Fillable COURT CODE: CISG Self-Represented DISTRICT COURT CLARK COUNTY, (Family Law Self Help Center)

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COURT CODE: CISG Self-Represented DISTRICT COURT CLARK COUNTY, (Family Law Self Help Center)

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© 2018 Family Law Self-Help Center
Page 1 of 3 – Confidential Information Sheet (Child)
COURT CODE: CISG
Your Name:
Address:
City, State, Zip:
Telephone:
Email Address:
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Guardianship of the:
Person
Estate
Person and Estate
of:
_
___________________________________,
_
___________________________________,
_
___________________________________,
_
___________________________________,
_
___________________________________,
_
___________________________________
(name of children who need a guardian)
Proposed Protected Minors.
CASE NO.: ____________________
DEPT: ____________________
CONFIDENTIAL INFORMATION SHEET – GUARDIANSHIP
First Guardian (full legal name): __________________________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Birth Certificate
Valid Driver’s License Number
Valid Identification Card
Number
Valid Passport Number
Second Guardian (full legal name, or “n/a” if none): ___________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Birth Certificate
Valid Driver’s License Number
Valid Identification Card
Number
Valid Passport Number
Page 2 of 3 – Confidential Information Sheet (Child)
First Child (child’s full legal name): ________________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Birth Certificate
Valid Driver’s License Number
Valid Identification Card
Number
Valid Passport Number
Second Child (child’s full legal name): ________________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Birth Certificate
Valid Driver’s License Number
Valid Identification Card
Number
Valid Passport Number
Third Child (child’s full legal name): ________________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Birth Certificate
Valid Driver’s License Number
Valid Identification Card
Number
Valid Passport Number
Fourth Child (child’s full legal name): ________________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Birth Certificate
Valid Driver’s License Number
Valid Identification Card
Number
Valid Passport Number
Fifth Child (child’s full legal name): ________________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Birth Certificate
Valid Driver’s License Number
Valid Identification Card
Number
Valid Passport Number
Sixth Child (child’s full legal name): ________________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Birth Certificate
Valid Driver’s License Number
Valid Identification Card
Number
Valid Passport Number
Page 3 of 3 – Confidential Information Sheet (Child)
Placement Of Child: Location Of Guardian(s):
With Guardian
Secured Facility
Group Home
Host Family
Family/Friends
Out of State
Other
Nevada
Other State (list): _____________________
Proposed Guardian(s) Relationship to the
Child:
Relative
Private: License Number: ___________
Other
First Child’s Gender: Child’s Date Of Birth:
Male
Female
Date of Birth: _______________________
Date Child Turns 18: _________________
Second Child’s Gender:
Child’s Date Of Birth:
Male
Female
Date of Birth: _______________________
Date Child Turns 18: _________________
Third Child’s Gender:
Child’s Date Of Birth:
Male
Female
Date of Birth: _______________________
Date Child Turns 18: _________________
Fourth Child’s Gender:
Child’s Date Of Birth:
Male
Female
Date of Birth: _______________________
Date Child Turns 18: _________________
Fifth Child’s Gender:
Child’s Date Of Birth:
Male
Female
Date of Birth: _______________________
Date Child Turns 18: _________________
Sixth Child’s Gender:
Child’s Date Of Birth:
Male
Female
Date of Birth: _______________________
Date Child Turns 18: _________________
Submitted by:
(Attach copies of the identification
indicated for each guardian and the
child)
(Signature)
(Printed Name)
/s/
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COURT CODE: CISG Self-Represented DISTRICT COURT CLARK COUNTY, (Family Law Self Help Center)

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Completed 15 January 2021

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