Fillable INVESTIGATION QUESTIONNAIRE In and for the County of (California)

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INVESTIGATION QUESTIONNAIRE In and for the County of (California)

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FL/E-LP-647 (adopted 6/10; rev’d 2/17) Investigation Questionnaire Page 1 of 6
Mandatory
In the Superior Court of the State of California
In and for the County of Sacramento
INVESTIGATION QUESTIONNAIRE
FOR COURT USE ONLY
CASE NAME:
CASE NUMBER:
Instructions to Petitioner:
In order to facilitate a stepparent (or domestic partner) adoption or termination of parental rights, you must complete this questionnaire
and provide copies of the required documents as indicated to:
SACRAMENTO COUNTY SUPERIOR COURT
3341 Power Inn Road, Family Law
Sacramento, CA 95826
The questionnaire is important in introducing you and your situation to the investigator handling your case. Attach all additional
documents as applicable to this questionnaire. The court will not file an incomplete packet or schedule a hearing date until all of the
necessary forms are completed and submitted to the court.
I. P E T I T I O N E R
Your current name: Driver’s License No.:
Maiden name and/or any other names used:
Name & telephone number of your attorney: ( )
Your current address (Street, City, State and ZIP):
How long at this address? Years Months
Home Telephone: ( ) Business Telephone: ( )
If no home or business telephone, give a contact number where the investigator can reach you: ( )
II. I D E N T I F Y I N G D A T A O F P E T I T I O N E R
Social Security Number: Age: Date of Birth: Place of Birth:
Race: Eye Color: Hair Color: Wgt: Hgt:
Extent of schooling, H.S./College, etc.:
Insurance (Life, Health, Car, etc.) specify:
FL/E-LP-647 (adopted 6/10; rev’d 2/17) Investigation Questionnaire Page 2 of 6
Mandatory
III. M A R I T A L H I S T O R Y O F P E T I T I O N E R
(List all marriages)
Time
Name of spouse (use maiden
names) include present marriage
Date of Marriage Date Separated
Date & How Terminated Number of
Children
First
/ / / /
Second
/ / / /
Third
/ / / /
**Attach a certified copy of the current marriage license or Certificate of Registered Domestic Partnership**
**If applicable, attach a certified copy of the final divorce judgment of each previous marriage**
**If applicable, attach a certified copy of any orders changing your name**
IV. C H I L D
(List the child INVOLVED with this Court action)
Name Date of
Birth
Living with Address Name of
other parent
Indian Ancestry?
/ /
yes no
Has the child ever been involved in any other court case? Yes No
If so, what county ________________, case number _____________________.
**Attach certified copy of the birth certificate**
**If applicable, attach a certified copy of the Order of Adoption, if the minor has been previously adopted**
**If applicable, attach a certified copy of the most recent court order awarding custody of the child to be adopted or an Order Terminating**
Parental Rights or Order Declaring Minor Free from Parental Custody and Control
**If applicable, attach a certified copy of any orders changing the child’s name**
V. C H I L D R E N
(List all your other children NOT INVOLVED in the Court action)
Name Date of
Birth
Living with Address Name of other
parent
/ /
/ /
/ /
/ /
Since the separation of the parents of the minor(s), whom have the child(ren) been living with? Also list dates:
VI. H E A L T H O F C H I L D R E N
(List each child in this case who has recently been under the care of a Doctor, or Psychiatrist, including family physician)
Child Doctor Address Date Reason
/ /
/ /
/ /
/ /
FL/E-LP-647 (adopted 6/10; rev’d 2/17) Investigation Questionnaire Page 3 of 6
Mandatory
Do any of the children presently have physical or mental problems? Yes No If “Yes”, please explain:
Plan of custody/visitation:
Place of residence for self and children:
Will children be placed under supervision of others? Yes
No If “Yes”, please complete below:
Name of caretaker: Relationship
to children
Address Phone Number What period of time
( )
( )
State the reasons why you feel the other parent should not have custody/visitation and be specific.
Give examples and dates (attach additional sheet, if needed).
VII. E M P L O Y M E N T
(Beginning with your present employment, list employment for the last 5 years)
Name of Employer Address of Employer Type of Job Date Begun Date Left Reason for Leaving
/ / / /
/ / / /
/ / / /
/ / / /
Current working hours and days:
M O N T H L Y I N C O M E Gross Net
From employment $ $
Own business $ $
Public Assistance (AFDC or Social Security Assistance) $ $
Child support $ $
Other sources $ $
TOTAL
$ $
Does the petitioner pay child support? Yes No
If yes, is the amount in the arrears? Yes
No If yes, amount in arrears $_________
FL/E-LP-647 (adopted 6/10; rev’d 2/17) Investigation Questionnaire Page 4 of 6
Mandatory
VIII. M E D I C A L H I S T O R Y O F P E T I T I O N E R
(If either parent or guardian have any physical disability or have received psychiatric treatment or counseling, please complete the section below)
Name of Doctor & Address Name of Hospital & Address When Treated Nature of Illness
/ /
/ /
/ /
/ /
/ /
/ /
IX. C R I M I N A L R E C O R D O F P E T I T I O N E R
Does petitioner have a criminal record? Yes No If “Yes”, please give details:
Is petitioner on Probation or Parole? Yes No
If “Yes”, please give name of Probation Officer or Parole Agent: ______________________________________________
Area office: ( ) Phone number: ( )
Does the petitioner have any criminal actions pending: Yes No If “Yes”, please explain:
FL/E-LP-647 (adopted 6/10) Adoption Questionnaire Page 5 of 6
Mandatory
X. N A T U R A L F A T H E R
Name of natural father:
Date of last support:
Address:
Date of last contact with child:
Date of Birth:
Place of Birth: Race:
Occupation:
Employer:
Has he consented to Adoption: Yes No
Date of last contact with any other relative: / /
** If applicable, attach a certified copy of the death certificate, proof of parental rights being terminated, or orders changing father’s name **
M A R I T A L H I S T O R Y O F N A T U R A L F A T H E R
(List all marriages)
Time
Name of spouse (use maiden
names) include present marriage
Date of Marriage Date Separated
Date & How Terminated
Number of
Children
First
/ / / /
Second
/ / / /
Third
/ / / /
Is the child a result of a donorship? Yes
No Is yes, attach proof of donorship.
FL/E-LP-647 (adopted 6/10) Adoption Questionnaire Page 6 of 6
Mandatory
XI. NATURAL MOTHER
Name of natural mother:
Date of last support:
Address:
Date of last contact with child:
Date of Birth:
Place of Birth: Race:
Occupation:
Employer:
Has she consented to Adoption: Yes No
Date of last contact with any other relative: / /
** If applicable, attach a certified copy of the death certificate, proof of parental rights being terminated, or orders changing mother’s name **
M A R I T A L H I S T O R Y O F N A T U R A L MOTHER
(List all marriages)
Time
Name of spouse (use maiden
names) include present marriage
Date of Marriage Date Separated
Date & How Terminated
Number of
Children
First
/ / / /
Second
/ / / /
Third
/ / / /
Before submitting your documents to the court, confirm that
you have attached all required documents to this packet
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INVESTIGATION QUESTIONNAIRE In and for the County of (California)

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Completed 18 July 2021

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