Fillable REFERRAL FOR COURT INVESTIGATOR & QUESTIONNAIRE - GUARDIANSHIP

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REFERRAL FOR COURT INVESTIGATOR & QUESTIONNAIRE - GUARDIANSHIP

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ATTACHMENT PB-4005
For Court use only:
Temp hrg date: __________________
Perm hrg date: __________________
CONFIDENTIAL – DO NOT PUT IN COURT FILE
REFERRAL FOR COURT INVESTIGATOR & QUESTIONNAIRE - GUARDIANSHIP
(PROBATE)
Rev. 1/01/07 Page 1 of 2
PB-4005
REFERRAL FOR COURT INVESTIGATOR
& QUESTIONNAIRE - GUARDIANSHIP
Case Number (if you have one):
Guardianship of (name): Person Estate
Do you think anyone will disagree with the guardianship? Yes No
If yes, who? Name: Telephone number:
Has Child Protective Services (CPS) ever been called about the child(ren) in this case? Yes
No
If yes, which County:
Santa Clara Other (County name):
Are there any custody orders about the child(ren) in this case?
Yes No
If yes, which County:
Santa Clara Other (County name):
Information about the CHILD(REN)
Child
n Name:
Birth Date:
Social Security Number:
School, Grade, School Telephone Number:
Child o Name:
Birth Date:
Social Security number:
School, Grade, School Telephone Number:
Child
p Name:
Birth Date:
Social Security Number:
School, Grade, School Telephone Number:
Check if there are more children in the case add information about them on another page.
To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at
the end of the form when
finished.
ATTACHMENT PB-4005
CONFIDENTIAL – DO NOT PUT IN COURT FILE
REFERRAL FOR COURT INVESTIGATOR & QUESTIONNAIRE - GUARDIANSHIP
(Probate)
Rev. 1/.01/07 Page 2 of 3
PB-4005
Information about the PROPOSED GUARDIANS’S ATTORNEY
Proposed Guardian doesn’t have an attorney
Name:
Address:
Phone Number:
Fax Number:
Information about the PROPOSED GUARDIAN(S)
Proposed Guardian n:
Name:
Relationship to child(ren): Grandparent Aunt/Uncle Other:
Birth Date:
Social Security Number:
Driver’s License Number:
Home Address:
Home Phone Number: Cell Phone Number:
Work Address:
Work Phone Number: Fax Number:
Proposed Guardian o:
Name:
Relationship to child(ren): Grandparent Aunt/Uncle Other:
Birth Date:
Social Security Number:
Driver’s License Number:
Home Address:
Home Phone Number: Cell Phone Number:
Work Address:
Work Phone Number: Fax Number:
All proposed Guardians must answer these questions:
1. Have you ever been convicted of a misdemeanor or felony offense? Yes No
If
yes, what offense(s): Date: County:
2. Is there a social worker, probation or parole officer supervising you or ANY person who lives with you?
Yes No
If
yes, explain:
ATTACHMENT PB-4005
CONFIDENTIAL – DO NOT PUT IN COURT FILE
REFERRAL FOR COURT INVESTIGATOR & QUESTIONNAIRE - GUARDIANSHIP
(Probate)
Rev. 1/.01/07 Page 3 of 3
PB-4005
I/We declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
Proposed Guardian 1 signs here:
Date:
Proposed Guardian 2 signs here:
Information about OTHER ADULTS (age 18 or older) WHO LIVE IN YOUR HOME
Name:
Birth Date:
Social Security Number:
Driver’s License Number: State:
Name:
Birth Date:
Social Security Number:
Driver’s License Number: State:
Name:
Birth Date:
Social Security Number:
Driver’s License Number: State:
Name:
Birth Date:
Social Security Number:
Driver’s License Number: State:
Name:
Birth Date:
Social Security Number:
Driver’s License Number: State:
More adults live in my home. I’ve attached information about them on a separate page.
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REFERRAL FOR COURT INVESTIGATOR & QUESTIONNAIRE - GUARDIANSHIP

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Completed 10 February 2021

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