700-00070C – Petition to Appoint Custodial Guardian for a Minor (06/2020) Page 3 of 5
PLEASE PROVIDE COPIES OF ANY COURT ORDERS WITH YOUR FILING
8. Other legal proceedings involving the minor child, parent or proposed guardian (check all that apply.
For each proceeding, check the person or persons involved in the proceeding)
☐ Juvenile delinquency ☐minor ☐parent ☐guardian
☐ CHINS (Child in Need of Care or Supervision)
Abuse/Neglect or Unmanageable
☐minor ☐parent ☐guardian
☐ Domestic Violence
(relief from abuse or restraining order) ☐minor ☐parent ☐guardian
☐ Divorce ☐minor ☐parent ☐guardian
☐ Paternity ☐minor ☐parent ☐guardian
☐ Adoption ☐minor ☐parent ☐guardian
☐ Conviction for a crime ☐minor ☐parent ☐guardian
☐ Other Court proceeding ☐minor ☐parent ☐guardian
Specify type of proceeding:
9. Is DCF (Department for Children and Families) involved with this child? ☐Yes ☐No
If yes, provide the name of the DCF social worker, if known:
10. Is there an existing child support order for this child? ☐Yes ☐No
If the guardianship is approved, does the proposed guardian expect to receive child support or financial
benefits for the child? ☐Yes ☐No
11. Is the child a recipient of social security benefits? ☐Yes ☐No
If yes, provide the name of the representative payee, if known:
12. Is there an existing parent child contact (visitation) order that affects the child? ☐Yes ☐No
If yes, either attach a copy of the most recent court order or provide information about the order
including the schedule of contact, the name of the person entitled to contact and whether the contact
currently takes place:
13.
Is there any reason why the child should not have contact with the parents? ☐Yes ☐ No
If yes, describe the reasons in detail: