Fill - Free fillable Sample For Guardianship Petition Starter Kit (Superior Court of California) PDF form

 Self Help Info & Free Forms: www.courts.ca.gov/selfhelp OR www.sb-court.org (Court Website)

 Email Assistance:

selfhelpforms@sb-court.org

Resource Center Services & Hours:

First Come, First Served . . . Arrive early!

SAN BERNARDINO HISTORIC COURTHOUSE

New Guardianship Petitions

Reviewed

on Mondays ONLY

TUESDAYS to THURSDAYS 8:30am

to 4:00pm*

*Assistance with other guardianship issues (no petitions)

It may take more than an hour to review your papers, so please arrive early!

Demand for self help services may exceed staff availability on any given day.

Black Ink Only. Do NOT use white out on your forms.

Locations:



San Bernardino Historic Courthouse, 351 N. Arrowhead, 1st Floor

 Victorville Courthouse, 14455 Civic Drive, Near V-10

SUPERIOR COURT OF CALIFORNIA

COUNTY OF SAN BERNARDINO

Updated 7/26/16

RESOURCE CENTER

SAMPLE

Guardianship Petition

VICTORVILLE COURTHOUSE

New Guardianship Petitions

Reviewed

on Thursdays ONLY

Space is limited at both locations to the first 3 customers with

completed petitions.

GC-110

FOR COURT USE ONLY

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

MINOR

CASE NUMBER:

Person* Estate*

requests that

Petitioner (name each):

(Name):

bond be fixed. It will be furnished by an admitted surety insurer or as otherwise provided by law.$

(Specify reasons in Attachment 1c if the amount is different from maximum required by Probate Code section 2320

and Cal. Rules of Court, rule 7.207(c).)

(3)

(Specify institution and location):

Current telephone no.:Current address:

provide for temporary care, maintenance, and support

as follows):specified in attachment 3

Probate Code, § 2250;

Cal. Rules of Court, rules 7.101, 7.1012

www.courtinfo.ca.gov

PETITION FOR APPOINTMENT OF

TEMPORARY GUARDIAN

(Probate—Guardianships and Conservatorships)

Form Adopted for Mandatory and Alternative

Mandatory Use Instead of Form GC-110(P)

Judicial Council of California

GC-110 [Rev. July 1, 2008]

(Name):

in deposits in a blocked account be allowed. Receipts will be filed.

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

FAX NO. (Optional):TELEPHONE NO.:

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

Page 1 of 2

bond not be required because petition is for a temporary guardianship of the person only.

bond not be required for the reasons stated in attachment 1c.

(1)

(2)

(4)

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

(Address and

telephone number):

(Address and

telephone number):

*You MAY use this form or form GC-110(P) for a temporary guardianship of the person. You MUST use this form for a

temporary guardianship of the estate or the person and estate.

(Name):

TEMPORARY GUARDIANSHIP OF

PETITION FOR APPOINTMENT OF TEMPORARY GUARDIAN

HEARING DATE:

DEPT.:

TIME:

be appointed temporary guardian of the PERSON of the minor and Letters issue upon qualification.

be appointed temporary guardian of the ESTATE of the minor and Letters issue upon qualification.

e. the powers specified in attachment 1e be granted in addition to the powers provided by law.

d. a request for an exception to notice of the hearing on this petition for good cause is filed with this petition.

other orders be granted (specify in attachment 1f).

The minor is (name):

The minor requires a temporary guardian to

Person and Estate*

protect property from loss or injury because (facts are

Name & Address and phone number

of Proposed Guardian(s)

247 W. Third St.

San Bernardino, CA 92415

Probate Division

List all children for whom you need guardianship

✔

Name of proposed guardian(s)

Name & Address and phone number of

Proposed Guardian(s)

List all children over which you need a guardianship

Children's current address and phone number

✔

Explain why you need to get guardianship immediately. Is

the child in danger, sick, needs to be in school, etc..?

CASE NUMBER:

MINOR

Character and estimated value of the property of the estate (complete if a temporary guardianship of the estate or

person and estate is requested):

will will not attend the hearing.

Date:

* (Signature of all petitioners also required (Prob. Code, § 1020).)

(SIGNATURE OF ATTORNEY*)

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF PETITIONER)

(TYPE OR PRINT NAME)

(SIGNATURE OF PETITIONER)

GC-110 [Rev. July 1, 2008]

PETITION FOR APPOINTMENT OF

TEMPORARY GUARDIAN

(Probate—Guardianships and Conservatorships)

Page 2 of 2

pending the appeal under Probate Code section 1301.

GC-110

Annual gross income from all sources, including real and

personal property, wages, pensions, and public benefits:

Personal property:

Total:

All attachments to this form are incorporated by this reference as though placed here in this form. There are

attached to this form.

pages

Temporary guardianship is required

pending the hearing on the petition for appointment of a general guardian.

during the suspension of powers of the guardian.

(Name):

TEMPORARY GUARDIANSHIP OF

Petitioner believes the minor

3. (Facts supporting appointment of a temporary guardian (continued)):

Additional amount for cost of recovery on the bond, calculated

as required under Cal. Rules of Court, rule 7.207(c):

List all children for whom you need guardianship

Use this space to continue, if you need more room to explain.

✔

Fill-in

All Petitioners sign here

Print the date signed

Name of 1st Petitioner

1st Petitioner signs

Name of 2nd Petitioner

2nd Petitioner signs

GC-140

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

FOR COURT USE ONLY

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

ESTATE OF PERSON

MINOR

CASE NUMBER:

WARNING: THIS APPOINTMENT IS NOT EFFECTIVE UNTIL LETTERS HAVE ISSUED.

Judicial officer (name):

Time: Room:Dept.:Hearing date:

Petitioner (name):c.

Attorney for petitioner (name):

THE COURT FINDS

Notice of the time and place of hearing has been given as required by law.2.

has beenNotice of the time and place of hearingb.

3. provide for temporary care, maintenance, and support

THE COURT ORDERS

(Name):

(Telephone):(Address):

Probate Code, §§ 2250–2254

and Letters shall issue upon qualification.

Form Adopted for Mandatory Use

Judicial Council of California

GC-140 [Rev. January 1, 2009]

ORDER APPOINTING TEMPORARY GUARDIAN

(Probate—Guardianships and Conservatorships)

FAX NO. (Optional):

TELEPHONE NO.:

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

(Name):

TEMPORARY GUARDIANSHIP OF THE

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

ORDER APPOINTING TEMPORARY GUARDIAN

It is necessary that a temporary guardian be appointed to

pending an appeal under Probate Code section 1301.

Minor (name):

Attorney for minor (name):

Minor’s parents (names):

Attorney for minor’s parents (names):

Person with valid visitation order (name):

Attorney for person with valid visitation order (name):

Public Guardian (name):

Attorney for Public Guardian (name):

The petition for appointment of a temporary guardian came on for hearing as follows (check boxes c–l to indicate personal

presence):

protect property from loss or injury pending the hearing on the petition for appointment of a general guardian.

during the suspension of powers of the guardian.

is appointed temporary guardian of the PERSON of (name):

(Name):

(Telephone):(Address):

and Letters shall issue upon qualification.

is appointed temporary guardian of the ESTATE of (name):

Page 1 of 2

should be dispensed with for (names):

Name & Address and phone number

of Proposed Guardian(s)

247 W. Third St.

San Bernardino, CA 92415

Probate Division

✔

List all children for whom you need guardianship

✔

List each Petitioner

✔

Name & Address and phone number

of Proposed Guardian(s)

List all children for whom you need guardianship

CASE NUMBER:

(Name):

MINOR

Notice of hearing to the persons named in item 2b is dispensed with.

Bond is not required.

Bond is fixed at: $ to be furnished by an authorized surety company or as otherwiseb.

provided by law.

are ordered to be placed in a blocked account at (specify institution andDeposits of: $

location):

and receipts shall be filed. No withdrawals shall be made without a court order. Additional orders in attachment 6c.

Other orders as specified in attachment 8 are granted.

Unless modified by further order of the court, this order expires on (date):

Number of boxes checked in items 4–9:

Number of pages attached:

Date:

JUDICIAL OFFICER

SIGNATURE FOLLOWS LAST ATTACHMENT

GC-140 [Rev. January 1, 2009]

ORDER APPOINTING TEMPORARY GUARDIAN

(Probate—Guardianships and Conservatorships)

Page 2 of 2

10.

GC-140

TEMPORARY GUARDIANSHIP OF

The temporary guardian is not authorized to take possession of money or any other property without a specific court

order.

11.

In addition to the powers granted by law, the temporary guardian is granted other powers. These powers are specified

in attachment 7. below (specify):

List all children for whom you need guardianship

✔

Fill-in

The temporary is not authorized to take possession of money or any other property

without a specific court order.

of the

is appointed temporary

These Letters shall expire

WITNESS, clerk of the court, with seal of the court affixed.

(SEAL)

Clerk, by

, Deputy

Probate Code, §§ 2250 et seq., 2890–2893;

Code of Civil Procedure, § 2015.6

www.courts.ca.gov

Form Adopted for Mandatory Use

Judicial Council of California

GC-150 [Rev. January 1, 2015]

LETTERS OF TEMPORARY GUARDIANSHIP OR

CONSERVATORSHIP

(Probate—Guardianships and Conservatorships)

Page 1 of 2

or upon earlier issuance of Letters to a general guardian or conservator.

This form may be recorded as notice of the establishment of a temporary conservatorship of the estate as provided in Probate Code section 1875.

(Name):

guardian conservator person

estate

of (name):

Other powers that have been granted or restrictions imposed on the temporary

guardian conservator are specified in Attachment 2.

specified below:

(date):

on other date

(specify):

guardian conservator

Number of pages attached:

Date:

LETTERS

ATTORNEY OR PARTY WITHOUT ATTORNEY (name, address, and State Bar number):

TEL NO.:

After recording, return to:

E-MAIL ADDRESS (optional):

FAX NO. (optional):

ATTORNEY FOR (name):

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

FOR RECORDER'S USE ONLY

OF (name):

TEMPORARY GUARDIANSHIP CONSERVATORSHIP

MINOR

CONSERVATEE

CASE NUMBER:

LETTERS OF TEMPORARY

GUARDIANSHIP CONSERVATORSHIP

Person

Estate

GC-150

FOR COURT USE ONLY

Name & Address of

EACH PETITIONER

Phone #

San Bernardino

247 W. Third St.

San Bernardino, CA 92415

Probate Division

List all children of this guardianship

Name of proposed guardian(s)

List all children over which you need a

guardianship

✔

Fill-in

When these Letters of Temporary Guardianship or Letters of Temporary Conservatorship (Letters) are delivered to you as an employee

or other representative of an institution or financial institution (described below) in order for the temporary guardian or temporary

conservator of the estate (1) to take possession or control of an asset of the minor or conservatee named above held by your institution

(including changing title, withdrawing all or any portion of the asset, or transferring all or any portion of the asset) or (2) to open or

change the name of an account or a safe-deposit box in your financial institution to reflect the guardianship or conservatorship, you

must fill out Judicial Council form GC-050 (for an institution) or form GC-051 (for a financial institution). An officer authorized by your

institution or financial institution must date and sign the form, and you must file the completed form with the court.

There is no filing fee for filing the form. You may either arrange for personal delivery of the form or mail it to the court for filing at the

address given for the court on page 1 of these Letters.

The temporary guardian or temporary conservator should deliver a blank copy of the appropriate form to you with these Letters, but it is

your institution’s or financial institution’s responsibility to complete the correct form, have an authorized officer sign it, and file the

completed form with the court. If the correct form is not delivered with these Letters or is unavailable for any other reason, blank copies

of the forms may be obtained from the court. The forms may also be accessed from the judicial branch’s public Web site free of charge.

The Internet address (URL) is www.courts.ca.gov/forms/. Select the form group Probate—Guardianships and Conservatorships and

scroll down to form GC-050 for an institution or form GC-051 for a financial institution. The forms may be printed out as blank forms and

filled in by typewriter, or may be filled out online and printed out ready for signature and filing.

An institution under California Probate Code section 2890(c) is an insurance company, insurance broker, insurance agent, investment

company, investment bank, securities broker-dealer, investment advisor, financial planner, financial advisor, or any other person who

takes, holds, or controls an asset subject to a conservatorship or guardianship other than a financial institution. Institutions must file a

Notice of Taking Possession or Control of an Asset of Minor or Conservatee (form GC-050) for an asset of the minor or conservatee

held by the institution. A single form may be filed for all affected assets held by the institution.

A financial institution under California Probate Code section 2892(b) is a bank, trust (including a Totten trust account but excluding

other trust arrangements described in Probate Code section 82(b)), savings and loan association, savings bank, industrial bank, or

credit union. Financial institutions must file a Notice of Opening or Changing a Guardianship or Conservatorship Account or Safe-

Deposit Box (form GC-051) for an account or a safe deposit box held by the financial institution. A single form may be filed for all

affected accounts or safe deposit boxes held by the financial institution.

AFFIRMATION

I solemnly affirm that I will perform according to law the duties of temporary

LETTERS OF TEMPORARY

GC-150

NOTICE TO INSTITUTIONS AND FINANCIAL INSTITUTIONS

(Probate Code sections 2890–2893)

CERTIFICATION

I certify that this document, including any attachments, is a correct copy of the original on file in my office and that the Letters issued to

the person appointed above have not been revoked, annulled, or set aside and are still in full force and effect.

Clerk, by

, Deputy

(SEAL)

(SIGNATURE OF APPOINTEE)

GC-150 [Rev. January 1, 2015]

Page 2 of 2

LETTERS OF TEMPORARY GUARDIANSHIP OR CONSERVATORSHIP

(Probate—Guardianships and Conservatorships)

GUARDIANSHIP CONSERVATORSHIP

guardian. conservator.

Executed on (date): , at (place):

(TYPE OR PRINT NAME)

Date:

OF (name):

TEMPORARY GUARDIANSHIP CONSERVATORSHIP

MINOR

CONSERVATEE

CASE NUMBER:

✔

List all children over which you need a guardianship

✔

Print date signed

City & State

Print name of each proposed guardian

Signature of proposed guardian(s)

See Rules of Court, Rule 5.165 for notice requirements -- no later than 10:00 am on the court day before the

matter is to be considered by the court or provide written explanation of exceptional circumstances.

SB-19447 Revised 3.11.13

-BLACK INK ONLY –

The undersigned hereby declares that I gave notice to the opposing party about

where and when the application for the emergency order would be made as follows:

Name of Party Notified/Served: _________________________________________________________

Date of Notice: ___________________ Time Notice Was Given: __________ ▭ A.M. ▭ P.M.

Form of Notice: ▭ Oral ▭ Written ▭ Other: _______________________

Information Given: That at ______ ▭A.M. ▭ P.M., on _______________________ (court date), the

moving party would appear at the Superior Court, located at:

_______________________________________________________________________________ California, in

Department _______ to ask for immediate temporary orders regarding:

▭ Custody ▭ Visitation ▭ Temporary Guardianship ▭ Restraining Order

▭ Residence Exclusion ▭ Property Control

▭ Other: _______________________________________________________________________

I have received the following response to this notice:

________________________________________________________________________________________________

_________________________________________________________________________________________________

CONTINUED ON BACK SIDE

Attorney or Party Without An Attorney (Name, State Bar No. & Address)

Telephone No.

Attorney for:

For Court Use Only

Superior Court of California, County of San Bernardino

Petitioner:

Respondent:

DECLARATION REGARDING EX PARTE NOTICE

TO OPPOSING PARTY

CASE NUMBER

NOTE: This form is filled out after you file your papers and notify

the parents.

Name & Address and phone number of

Proposed Guardian(s)

247 W. Third St.

San Bernardino, CA 92415

Probate Division

List all children for whom you need guardianship

Fill out the information to let the Court know that you gave

notice to the parents of the children. You need a separate form

for each parent you notify.

See Rules of Court, Rule 5.165 for notice requirements -- no later than 10:00 am on the court day before the

matter is to be considered by the court or provide written explanation of exceptional circumstances.

SB-19447 Revised 3.11.13

Is opposition expected from the other party? ▭ Yes ▭ No ▭Unknown

For All Cases Except Domestic Violence Restraining Order

▭ I have served the other party with a copy of the paperwork.

▭ I have not yet had a reasonable opportunity to serve the other party with the paperwork.

▭ My notice to the other party was later than 10:00am on the court day before the hearing. See the

attached declaration explaining the exceptional circumstances about why there was shorter notice.

►ALL CASES: You may ask the court to excuse you from giving notice to the other party for good cause.

If you did not give notice to the other party, you must write down your explanation here. Below you will

find a list of reasons from California Rules of Court Rule 5.165 why no notice may be acceptable.

_________________________________________________________________________

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and

correct.

Date: _________________________ Signed by: ___________________________________________

Street Address: _____________________________________

City/State/Zip: ______________________________________

California Rules of Court, Rule 5.165

 The party made reasonable and good faith efforts to give notice to the other party, and further efforts to give

notice would probably be futile or unduly burdensome;

 Giving notice would frustrate the purpose of the order;

 Giving notice would result in immediate and irreparable harm to the applicant or the children who may be

affected by the order sought;

 Giving notice would result in immediate and irreparable damage to or loss of property subject to disposition in

the case; or

 The parties agreed in advance that notice will not be necessary with respect to the matter that is the subject

of the request for emergency orders.

Sign and date. Take this form to your ex-parte hearing.

(Specify institution and location):

requests that

Petitioner (name each):

be appointed guardian of the PERSON of the minor or minors named in item 2 and Letters issue upon qualification.

(name):

(address):

(telephone):

be appointed guardian of the ESTATE of the minor or minors named in item 2 and Letters issue upon qualification.

(1)

(2)

(3)

Form Adopted for Mandatory

and Alternative Mandatory Use

Instead of Form GC-210(P)

Judicial Council of California

GC-210 [Rev. July 1, 2016]

Probate Code, §§ 1510, 1510.1;

Cal. Rules of Court, rule 7.101

www.courts.ca.gov

PETITION FOR APPOINTMENT OF GUARDIAN OF MINOR

(Probate—Guardianships and Conservatorships)

Page 1 of 3

Attached is a copy of Guardianship Petition—Child Information Attachment (form GC-210(CA)) for each minor for whom this

petition requests the appointment of a guardian. The full legal name and date of birth of each minor is:

**You MAY use this form or form GC-210(P) for a guardianship of the person. You MUST use this form for a guardianship of the estate or of

the person and estate. Do NOT use this form for a temporary guardianship.

guardian is a corporate fiduciary or an exempt government agency

bond not be required because the petition is for guardian of the person only because the proposed

for the reasons stated in Attachment 1c.

bond be fixed. It will be furnished by an authorized surety company or as otherwise provided by

law. (Specify reasons in Attachment 1c if the amount is different from the minimum required by Prob. Code, § 8482.)

in deposits in a blocked account be allowed. Receipts will be filed.

authorization be granted under Probate Code section 2590 to exercise the powers specified in Attachment 9.

orders relating to the powers and duties of the proposed guardian of the person under Probate Code sections 2351–2358

be granted (specify orders, facts, and reasons in Attachment 1e).

an order dispensing with notice to the persons named in Attachment 10 be granted.

other orders be granted (specify in Attachment 1g).

Name:

Date of Birth (month/day/year):

The names and dates of birth of additional minors are specified on Attachment 2 to this petition.

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

BRANCH NAME:

CITY AND ZIP CODE:

STREET ADDRESS:

MAILING ADDRESS:

GUARDIANSHIP OF (name):

FOR COURT USE ONLY

CASE NUMBER:

PETITION FOR APPOINTMENT OF GUARDIAN OF

Person** Estate**

MINOR* MINORS*

GC-210

ATTORNEY OR PARTY WITHOUT ATTORNEY

STATE: ZIP CODE:CITY:

STREET ADDRESS:

FIRM NAME:

NAME:

STATE BAR NO.:

TELEPHONE NO.: FAX NO.:

E-MAIL ADDRESS:

ATTORNEY FOR (name):

HEARING DATE AND TIME:

DEPT.:

(name):

(address):

(telephone):

Date of Birth (month/day/year):

*Under section 1510.1(d) of the Probate Code, the terms child, minor, and ward include a youth 18 to 20 years of age.

(Not applicable to proposed wards 18 years of age and older.)

Name & Address and phone number

of Proposed Guardian(s)

San Bernardino

247 W. Third St.

San Bernardino, CA 92415

Probate Division

List all children for whom you need guardianship

✔

Name(s) of person asking for the guardianship

Name & Address and phone number

of Proposed Guardian(s)

Guardians shall be allowed to apply for and receive public benefits and social security benefits for

the minor children.

✔

List all the children of this guardianship

and their birthdates.

Appointment of a guardian of the of the minor or minors named in item 2 is necessary or

convenient for the following reasons:

Total:

10.

GC-210 [Rev. July 1, 2016] Page 2 of 3

PETITION FOR APPOINTMENT OF GUARDIAN OF MINOR

(Probate—Guardianships and Conservatorships)

Annual gross income from all sources, including real and

personal property, wages, pensions, and public benefits:

Personal property:a.

The proposed guardian is (check all that apply):

Petitioner is3.

related to the minor or minors named in item 2, as shown in item 7 of each minor's attached form GC-210(CA).

the minor named in item 2, who is 12 years of age or older.

another person on behalf of minor or minors named in item 2, as shown in item 7 of each minor's attached form

GC-210(CA).

a nominee (affix a copy of nomination as Attachment 4a or file Nomination of Guardian (form GC-211, items 2 and 3)

with this petition.

related to the minor or minors named in item 2, as shown in item 3 of each minor's attached form GC-210(CA).

other, as shown in item 3 of each minor's attached form GC-210(CA).

a professional fiduciary within the meaning of the Professional Fiduciaries Act.The proposed guardian's license status is

shown in item 1 on page 1 of the attached Professional Fiduciary Attachment. (Use form GC-210(A-PF)/GC-310(A-PF)

for this attachment.)

Petitioner, with intent to adopt, has accepted or intends to accept physical care or custody of the minor.

A person other than the proposed guardian has been nominated as the guardian of the minor by

writing. A copy of the nomination is affixed as Attachment 6. (Specify name and address of nominee in item 2 of minor's

attached form GC-210(CA).)

will other

Character and estimated value of property of the estate (complete if petition requests appointment of a guardian of the estate

or the person and estate):

Real property: $

person estate

Continued in Attachment 8. Parental custody would be detrimental to the minor or minors named in item 2

Granting the proposed guardian of the estate powers to be exercised independently under Probate Code section 2590 would

be to the advantage and benefit and in the best interest of the guardianship estate. Reasons for this request and the powers

requested are specified in Attachment 9.

Notice to the persons named in Attachment 10 should be dispensed with under Probate Code section 1511 because

they cannot with reasonable diligence be given notice (specify names and efforts to locate in Attachment 10).

giving notice to them would be contrary to the interest of justice (specify names and reasons in Attachment 10).

GC-210

CASE NUMBER:

GUARDIANSHIP OF (name):

(not applicable to proposed wards 18 years of age and older).

List all children for whom you need guardianship

Mark the boxes to answer #3 & 4 -

Check the appropriate boxes

describing the guardian(s)'s

relationship to the minor(s).

✔

Explain why the guardianship is necessary

*(All petitioners and the proposed ward—if he or she is at least 18 years of age but not yet 21 and not a petitioner—must also sign.)

(SIGNATURE OF ATTORNEY*)

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

(SIGNATURE OF PETITIONER)

14.

Filed with this petition are the following (check all that apply):

12.

All attachments to this form are incorporated by this reference as though placed here in this form. Number of pages attached:

(SIGNATURE OF PETITIONER)

13.

The proposed guardian's home a licensed foster family home.c.

11.

(Complete this item if this petition is filed by a person who is not related to a minor named in item 2 and is not a petition for

appointment of a guardian of the estate only.)

Petitioner is the proposed guardian and will promptly furnish all information requested by any agency referred to in

Probate Code section 1543.

Petitioner is not the proposed guardian. A statement by the proposed guardian that he or she will promptly furnish all

information requested by any agency referred to in Probate Code section 1543 is affixed as Attachment 11b.

is is not

The proposed guardian has never filed a petition for adoption of the minor except as specified in Attachment 11d.

Attached to this petition is a Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) (form

GC-120) concerning each child under 18 years of age listed in item 2 (guardianship of the person or person and estate only).

Consent of Proposed Guardian (form GC-211, item 1)

Nomination of Guardian (form GC-211, items 2 and 3)

Consent to Appointment of Guardian and Waiver of Notice (form GC-211, item 4)

Petition for Appointment of Temporary Guardian (form GC-110)

Petition for Appointment of Temporary Guardian of the Person (form GC-110(P))

Confidential Guardianship Screening Form (form GC-212)

Other (specify):

Date:

(TYPE OR PRINT NAME)

GC-210

CASE NUMBER:

GUARDIANSHIP OF (name):

GC-210 [Rev. July 1, 2016] Page 3 of 3

PETITION FOR APPOINTMENT OF GUARDIAN OF MINOR

(Probate—Guardianships and Conservatorships)

Date:

(TYPE OR PRINT NAME)

Petition for Special Immigrant Juvenile Findings (form GC-220)

I consent to the appointment of the person named in item 1.a as guardian of my person and to his or her performance of the duties of a

guardian on my behalf.

(SIGNATURE OF PROPOSED WARD)

(TYPE OR PRINT NAME)

Date:

List all children for whom you need guardianship

Mark the boxes to answer the

questions.

✔

All Petitioners sign here

Print the date signed

Name of 1st Petitioner

1st Petitioner signs

Name of 2nd Petitioner

2nd Petitioner signs

Print the name(s) of the child(ren) age

12 or older who agree with the

guardianship and have them sign.

GC-210(CA)

Guardianship Petition—Child Information

Attachment

Fill out a separate copy of this form for each child for whom you want the court to appoint a guardian.

Case Number:

This form is attached to the Petition, item 2 of form GC-210, or

Judicial Council of California

www.courts.ca.gov

Revised July 1, 2012, Mandatory Form

Probate Code, §§ 1449, 1459.5, 1510;

Cal. Rules of Court, rule 7.1015

GC-210(CA), Page 1 of 5

Guardianship of (all children’s names):

This child’s name:

Tell the court about this child

Child’s full legal name:

Child’s current address:

Is this child a member of, or eligible for membership in, one or more Indian tribes recognized by the federal

Yes (specify tribe or tribes):No

Date of birth:

First Middle Last Month/Day/Year

No Yesd.

The Petition asks for the appointment of a guardian of this child’s (specify):

person estate person and estate

Is this child married?

married but the marriage was dissolved or ended in divorce? No

Yes

(The court cannot appoint a guardian of the person for a minor child who is married or whose marriage was

dissolved or ended in divorce.)

Never married If you checked “No,” was this child formerly

item 8 of form GC-210(P).

(1)

government?

Not sure

(2)

(If you checked “Yes” to item (1), this guardianship case is subject to ICWA. If you checked “Not sure” or

“No” to item (1), answer item (2).)

Custody Proceeding for Indian Child (form ICWA-030), in addition to service of any other notices required

in this case. For information about what is “reason to know whether the child is or may be an Indian child”

and the notice requirement, including who must be served, how to serve them, and how to prove to the court

that you have done so, and how to fill out and file the Notice, see the Information Sheet on Indian Child

Inquiry Attachments and Notice of Child Custody Proceeding For Indian Child (form ICWA-005-INFO).)

Yes

Guardianship Petition—Child Information Attachment

(Probate—Guardianships and Conservatorships)

Do you know or have reason to know (within the meaning of Prob. Code, §§ 1460.2(a), Welf. & Inst.

Code, § 224.3(b), and Cal. Rules of Court, rule 7.1015), whether this child is or may be an Indian child?

(If the Petition to which this form is attached asks for the appointment of a guardian of this child’s estate

only, skip this item 1c, select item a on page 5, and answer the rest of the items in this form. If the Petition

asks for the appointment of a guardian of this child’s person or this child’s person and estate, complete the

steps described here. Ask the child, if he or she is old enough, and the child’s parents or any other legal

guardian, and any Indian custodian, whether the child is or may be an Indian (Native American) child. You may

not rely merely on your own knowledge and belief about the child. If possible, ask these persons before you file

your petition, including this form, so you can use the information you receive to answer questions (1) and (2)

below. Answer those questions, item on page 5, and the rest of the items in this form.)

(For more information about your duties concerning a child who is or may be an Indian child involved in a

guardianship of the person under the Indian Child Welfare Act (“ICWA”) (25 U.S.C. § 1901 et seq.) and

California law, including making the inquiry described above and completing this form, see the Information

Sheet on Indian Child Inquiry Attachments and Notice of Child Custody Proceeding For Indian Child

(form ICWA-005-INFO).)

(If you checked “Yes” to either item (1) or (2), you must file and serve a Notice of Child

Each child requires a separate form GC-210(CA)

List all children for whom you need guardianship

Print the name of the child for this form.

✔

This child's name

This child's

birthdate

This child's address

Choose the

correct

answer for

your

situation.

✔

Case Number:

Guardianship of (all children’s names):

GC-210(CA), Page 2 of 5

Revised July 1, 2012

This child’s name:

Father

List the names and addresses of this child’s relatives and other persons shown below:

Relationship Name Home Address (Street, City, State, Zip)

Grandmother

(Mother’s mother)

Grandmother

(Father’s mother)

Grandfather

(Mother’s father)

Grandfather

(Father’s father)

Mother

h. (Check this box if this child has been involved in an adoption, juvenile court, marriage dissolution

(divorce), domestic relations, custody, or other similar court case.) Describe the court case below:

Type of Case Court District or County and State Case Number (if known)

(Check this box if this child is in or on leave from an institution supervised by the California Department of

Developmental Services or the California Department of Mental Health.) Write the name of the institution

here:

Tell the court about this child (continued)

(Check this box and fill out below if the person the child lives with is not the person with legal custody.)

Name and address of the person this child lives with (has the care of the child):

Is this child receiving public assistance? Unknown (If you checked “Yes,” fill out below.)

Yes

Type of Aid Monthly Benefit Type of Aid

TANF (Temporary Asst. for Needy Families)

Social Security

Dept. Veterans Affairs Benefits

Monthly Benefit

Other (explain):

Other (explain): $

f. Name and address of the person with legal custody of this child:

Guardianship Petition—Child Information Attachment

(Probate—Guardianships and Conservatorships)

List all children for whom you need guardianship

Print the name of the child for this form.

Choose

the correct

answer for

your

situation.

This is usually one or both of the child's parents. Not the people

requesting the guardianship.

If the child lives with the proposed guardian(s) or someone other

than the person in part "f" above, put their name here.

If applicable check "h" and fill in.

#2 is a list of all the people who will

have to be served. The minor(s) &

any siblings if age 12 or older will

also have to be served.

Father's name Father's address

Mother's name Mother's address

Paternal grandfather's name Paternal grandfather's address

Paternal grandmother's name Paternal grandmother's address

Maternal grandfather's name Maternal grandfather's address

Maternal grandmother's name Maternal grandmother's address

Case Number:

Guardianship of (all children’s names):

This child’s name:

GC-210(CA), Page 3 of 5

Revised July 1, 2012

Name (name all proposed guardians if more than one):

Information about the proposed guardian:

Relationship(s) to the child named in (check all that apply):

Relative (specify relationships of all proposed guardians to the child):

Not a relative (explain interest in or connection to this child ):

Person nominated

as guardian of this

child

Spouse

(Guardianship of

the estate only)

(Other than a proposed

guardian listed in )

Names and addresses of this child’s relatives and other persons (continued):

Relationship Name Home Address (Street, City, State, Zip)

(Check here if this child has additional brothers or sisters, including half-brothers and half-sisters, and list

their names and addresses on a separate sheet of paper. Write “Form GC-210(CA),” the name of this child,

and “Item 2:—Other Siblings” at the top of the paper and attach it to this form.)

Brother/Sister

Guardianship Petition—Child Information Attachment

(Probate—Guardianships and Conservatorships)

List all children for whom you need guardianship

Print the name of the child for this form.

Sibling(s) of the minor and

their age(s)

Print name of each proposed guardian

List relationship & specify which side of the family (mother's or father's)

If not related, explain what the connection is to this child.

Case Number:

Guardianship of (all children’s names):

This child’s name:

GC-210(CA), Page 4 of 5

Revised July 1, 2012

Suitability for guardianship of this child

Does this child live with the person in now?

If the court approves the guardianship, will this child live with the person in ?

Does the person in plan to adopt this child now?

Yes

Your relationship to this child:

Relative (specify):

Not a relative (explain your interest in or connection to this child):

Check this box if you (the petitioner) are not the person in , and fill in below.

Do one or both of this child’s parents agree that the person in can be the child’s guardian?

(You may file a filled-out Consent to Appointment of Guardian and Waiver of Notice (form GC-211, item 4)

signed by the child’s parent or parents (or any adult relative listed in ) who agree. The court may excuse you

from having to give notice of the court hearing on your request for appointment of a guardian to a parent or other

relative who signs that form.)

Yes

Father:

b. Mother: Yes

Not known at this time.

Explain why appointing the person in guardian would be best for this child:

(Check here if you need more space. Continue your explanation on a separate sheet of paper. Write “Form

GC-210(CA),” the name of this child, and “Attachment 4:—Best Interest of Child” at the top of the paper and

attach it to this form.)

Guardianship Petition—Child Information Attachment

(Probate—Guardianships and Conservatorships)

List all children for whom you need guardianship

Print the name of the child for this form.

Tell the judge why appointing the proposed

guardian(s) is best for the child (as opposed

to someone else).

Check the applicable

boxes

Fill in #7 only if the person asking for the

guardianship is not the proposed guardian.

The child or the child’s family has received services or benefits from a tribe or services that are

available to Indians from tribes or the federal government, such as the Indian Health Service or

Tribal Temporary Assistance to Needy Families (TANF).

The child is or may be a member of or eligible for membership in a tribe.

The child’s parents, grandparents, or great-grandparents are or were members of a tribe or tribes.

The residence or domicile of the child, the child’s parents, or the child’s Indian custodian is in a

predominantly Indian community.

An Indian child inquiry concerning the child named above:

has been made and the following information was obtained (check all that apply):

(3)

(4)

The child may have Indian ancestry.

The child has no known Indian ancestry.

Other reason or reasons to know the child is or may be an Indian child:

Tribe or tribes:

Band (if applicable):

GC-210(CA), Page 5 of 5

Guardianship Petition—Child Information Attachment

(Probate—Guardianships and Conservatorships)

Revised July 1, 2012

Case Number:

Guardianship of (all children’s names):

This child’s name:

is not required; this is a guardianship of the estate only. (If you check this box, skip the rest of item . .)

has not been made or completed for the following reasons (check all that apply):

Petitioner knows the child is an Indian child and has identified the child’s tribe or tribes in item .

Petitioner (or the proposed guardian if he or she is not the petitioner) is the child’s Indian custodian.

Petitioner has been unable to communicate with the child’s parents, other legal guardian, or Indian

(Check here if you need more space. Continue your explanation on a separate sheet of paper.

Write “Form GC-210(CA),” the name of this child, and “Attachment 8b(3):—Indian Child

Inquiry” at the top of the paper and attach it to this form.)

(2)

Tribe or tribes:

Band (if applicable):

(5)

(6)

(7)

(8)

(1)

The names, relationships to the child named above, addresses, and telephone numbers, of the persons

interviewed by Petitioner to collect or confirm the information given below, and the date or dates the

interviews took place, are provided on one or more separate sheets of paper attached to this form.

(Write “Form GC-210(CA),” the name of this child, and “Attachment 8c(1):—Indian Child Inquiry”

at the top of each page of paper you attach to this form to complete this item.)

(1)

(2)

(3)

custodian for the following reasons and despite the following efforts to do so (describe):

Except as otherwise stated in this form, the statements made in the Petition to which this form is attached fully

apply to this child.

List all children for whom you need guardianship

Print the name of the child for this form.

Fill out ALL the requested

information on this page

This page will usually have "c"

and "8" checked unless the child

has Indian ancestry.

CONSENT OF PROPOSED GUARDIAN, NOMINATION OF GUARDIAN,

AND CONSENT TO APPOINTMENT OF GUARDIAN AND WAIVER OF NOTICE

CONSENT OF PROPOSED GUARDIAN

I consent to serve as guardian of the

person

estate of the minor.

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF PROPOSED GUARDIAN)

NOMINATION OF GUARDIAN

I am a parent of the minor a donor of a gift to the minor. I nominate (name and address):

estate of the minor.personas guardian of the

Date:

(SIGNATURE)

(TYPE OR PRINT NAME)

CONSENT TO APPOINTMENT OF GUARDIAN AND WAIVER OF NOTICE

I consent to appointment of the guardian as requested in the Petition for Appointment of Guardian of Minor, filed on

(SIGNATURE)

Continued on Attachment 4.

Form Adopted for Mandatory Use

Judicial Council of California

GC-211 [Rev. January 1, 2004]

Probate Code, §§ 1204,

1500–1502

The guardian of the person of a minor child has full legal and physical custody until the child becomes

an adult or is adopted, the court changes guardians, or the court terminates the guardianship.

Parents or other interested persons must petition the court to terminate the guardianship. The court

will not do so unless the judge decides that termination would be in the child's best interest.

I am a parent of the minor a donor of a gift to the minor. I nominate (name and address):

NOTICE:

Page 1 of 1

FOR COURT USE ONLY

CASE NUMBER:

GC-211

PERSON ESTATE OF (Name):GUARDIANSHIP OF THE

CONSENT OF PROPOSED GUARDIAN

NOMINATION OF GUARDIAN

CONSENT TO APPOINTMENT OF GUARDIAN AND WAIVER OF NOTICE

(TYPE OR PRINT NAME)DATE

RELATIONSHIP TO MINOR

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

FAX NO. (Optional):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

TELEPHONE NO.:

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

(date):

notice of any request for independent powers contained in it. I waive timely receipt of a copy of the petition.

. I am entitled to notice in this proceeding, but I waive notice of hearing of the petition, including

Name & Address and phone number

of Proposed Guardian(s)

247 W. Third St.

San Bernardino, CA 92415

Probate Division

List all children for whom you need guardianship

✔

Print the date signed

If a parent, grandparent, or sibling 12

yrs or older consents to the

guardianship, they can sign here.

Print name of each proposed guardian

Signature of proposed guardian(s)

This section is used when a

parent of the minor wants to

nominate a person to be

guardian of their child.

American LegalNet, Inc.

www.FormsWorkflow.com

CONFIDENTIAL (DO NOT ATTACH TO PETITION)

GC-212

FOR COURT USE ONLY

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

FAX NO. (Optional):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

GUARDIANSHIP OF

MINOR

CONFIDENTIAL GUARDIAN SCREENING FORM

CASE NUMBER:

PersonGuardianship of

Estate

The proposed guardian must complete and sign this form. The person requesting appointment of a

guardian must submit the completed and signed form to the court with the guardianship petition.

How This Form Will Be Used

This form is confidential and will not be a part of the public file in this case. Each proposed guardian must complete and sign a

separate copy of this form under rule 7.1001 of the California Rules of Court. The information provided will be used by the court and

by persons and agencies designated by the court to assist the court in determining whether to appoint the proposed guardian as

guardian. The proposed guardian must respond to each item.

State:

Work: Other:

2. I am I am not required to register as a sex offender under California Penal Code section 290.

(If you checked "I am," explain in Attachment 2.)

3. I have

4. I have had a restraining order or protective order filed against me in the last 10 years.

(If you checked "I have," explain in Attachment 4.)

5. I am I am not receiving services from a psychiatrist, psychologist, or therapist for a mental health–related issue.

(If you checked "I am," explain in Attachment 5.)

Do you, or does any other person living in your home, have a social worker or parole or probation officer assigned to him or her?

Yes

(If you checked "Yes," explain in Attachment 6 and provide the name and address of each social

worker, parole officer, or probation officer.)

Have you, or has any other person living in your home, been charged with, arrested for, or convicted of any form of child abuse,

Yes

Form Adopted for Mandatory Use

Judicial Council of California

GC-212 [Rev. July 1, 2009]

CONFIDENTIAL GUARDIAN SCREENING FORM

(Probate—Guardianships and Conservatorships)

TELEPHONE NO.:

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

Probate Code, § 1516;

Family Code, § 3011;

Cal. Rules of Court, rule 7.1001

www.courtinfo.ca.gov

Page 1 of 2

Proposed guardian (name):

Telephone numbers: Home:

Date of birth:

Social security number:

Driver's license number:

I have not

(Check here if you have been arrested for drug or alcohol-related offenses.)

I have not

been charged with, arrested for, or convicted of a crime deemed to be a felony or a

misdemeanor. (If you checked "I have," explain in Attachment 3.)

neglect, or molestation?

I am I am not aware of any reports alleging any form of child abuse, neglect, or molestation made to any

agency charged with protecting children (e.g., Child Protective Services) or any other law

enforcement agency regarding me or any other person living in my home. (If you checked "I am,"

explain in Attachment 8 and provide the name and address of each agency.)

Have you, or has any other person living in your home, habitually used any illegal substances or abused alcohol?9.

Yes (If you checked "Yes," explain in Attachment 9.)No

This form must remain confidential.

(Name):

No (If you checked "Yes," explain in Attachment 7.)

HEARING DATE AND TIME: DEPT.:

Each proposed guardian must fill-out a separate Screening form.

Name & Address and phone number

of Proposed Guardian(s)

247 W. Third St.

San Bernardino, CA 92415

Probate Division

List all children for whom you need guardianship

✔

Name of proposed guardian

Fill in your

information in #1

Choose the correct

answer for each

question through #19.

CONFIDENTIAL

GUARDIANSHIP OF (Name):

CASE NUMBER:

MINOR

Do you or does any other person living in your home suffer from mental illness?

Yes

(If you checked "Yes," explain in Attachment 11.)

Do you suffer from any physical disability that would impair your ability to perform the duties of guardian?

Yes (If you checked 'Yes," explain in Attachment 12.)

13. I have or may have

14. I have I have not previously been appointed guardian, conservator, executor, or fiduciary in another proceeding.

(If you checked "I have," explain in Attachment 14.)

15. I have I have not been removed as guardian, conservator, executor, or fiduciary in any other proceeding.

(If you checked "I have," explain in Attachment 15.)

I have I have not filed for bankruptcy protection within the last 10 years.

(If you checked "I have," explain in Attachment 19.)

19.

MINORS' CONTACT INFORMATION

School (name):

School telephone: Other telephone:

Minor's name: School (name):

Information on additional minors is attached.

DECLARATION

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

(SIGNATURE OF PROPOSED GUARDIAN)*(TYPE OR PRINT NAME OF PROPOSED GUARDIAN)

* Each proposed guardian must fill out and file a separate screening form.

CONFIDENTIAL GUARDIAN SCREENING FORM

(Probate—Guardianships and Conservatorships)

GC-212 [Rev. July 1, 2009]

11.

12.

Page 2 of 2

Have you, or has any other person living in your home, been charged with, arrested for, or convicted of a crime involving illegal

substances or alcohol?

Yes (If you checked "Yes," explain in Attachment 10.)

10.

effect on, my ability to faithfully perform the duties of guardian.

(If you checked "I have or may have," explain in Attachment 13.)

I do not have an adverse interest that the court may consider to be a risk to, or to have an

I am I am not

16.

18.

I am I am not

17.

I am I am not a responsible corporate officer authorized to act for (name of corporation):

20.

21.

22.

Home telephone:

Home telephone: School telephone:

School telephone:

Other telephone:

a California nonprofit charitable corporation that meets the requirements for appointment as

guardian of the proposed ward under Probate Code section 2104. I certify that the

corporation's articles of incorporation specifically authorize it to accept appointments as

guardian. (If you checked "I am," explain the circumstances of the corporation's care of,

counseling of, or financial assistance to the proposed ward in Attachment 18.)

Minor's name:

Home telephone:

GC-212

a private professional fiduciary, as defined in Business and Professions Code section 6501(f).

(If you checked "I am," respond to item 17. If you checked "I am not," go to item 18.)

currently licensed by the Professional Fiduciaries Bureau of the Department of Consumer

Affairs. My license status and information is stated in item 1 on page 1 of the Professional

Fiduciary Attachment signed by me and attached to the petition that proposes my appointment

as guardian in this matter. (Complete and sign the Professional Fiduciary Attachment and

attach it to the petition, or deliver it to the petitioner for attachment, before the petition is filed.

See item 4d of the petition. Use form GC-210(A-PF)/GC-310(A-PF) for this attachment.)

List all children for whom you need guardianship

Fill in the information for each child of

this guardianship

Print date

Name of proposed guardian

Signature of proposed guardian

Local Court Form (Rev. 6-28-2016)

SB18074

CONFIDENTIAL GUARDIANSHIP QUESTIONNAIRE AND

AUTHORIZATION FOR RELEASE OF INFORMATION

Page 1 of 7

Probate Code § 1513

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

FOR COURT USE ONLY

NAME:

STATE BAR NUMBER:

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

TELEPHONE NO:

ATTORNEY FOR (Name):

FAX NO.(Optional)

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO

STREET ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

GUARDIANSHIP OF THE

PERSON

ESTATE

(Minor’s Name)

CONFIDENTIAL GUARDIANSHIP QUESTIONNAIRE

AND AUTHORIZATION FOR RELEASE OF INFORMATION

(Probate Code Section 1513)

CASE NUMBER:

NOTICE TO PROPOSED GUARDIAN OR APPLICANT AND RELEASE OF INFORMATION

Each proposed guardian must complete a separate questionnaire.

Please be advised, the information provided on this questionnaire will be used to

conduct a full and complete investigation of applicant’s background. The results of the

investigation and relationship histories will be fully reported to the court.

Re: Guardianship of (Minor’s name):

(Minor’s name):

I give the Court Investigator’s Office authority to release any information in its files to

the Guardianship Court Investigator’s Office. Such information may include, but is not

limited to, school records, medical records, employment records, and psychological

records.

The Guardianship Court Investigator’s Office utilizes this information to complete its

required investigation in connection with my petition for guardianship of a minor child.

I have read and understand the above conditions and agree to them.

PRINT NAME OF PROPOSED GUARDIAN OR APPLICANT SIGNATURE OF PROPOSED GUARDIAN OR APPLICANT Date

Each proposed guardian must fill-out a separate Questionnaire form.

Name & Address and phone

number of Proposed Guardian(s)

✔

247 W. Third St.

San Bernardino, CA 92415

Probate Division

List all children for whom you need guardianship

List all children for whom you need

guardianship

Name of proposed guardian

Signature of proposed guardian

Print date

Local Court Form (Rev. 6-28-2016)

SB18074

CONFIDENTIAL GUARDIANSHIP QUESTIONNAIRE AND

AUTHORIZATION FOR RELEASE OF INFORMATION

Page 2 of 7

Probate Code § 1513

Relative (relationship) __________________________ Non-Relative

PROPOSED GUARDIAN INFORMATION

Proposed Guardian:

Last

First

Middle

Maiden Name

Phone numbers

Home:

Work:

Cell:

Address:

City:

Zip:

Place of Birth:

Date of Birth:

Social Security Number:

Driver’s License Number:

Race or Ethnicity:

Will you or anyone else in the home require an interpreter? Yes No

Language:

DESCRIBE YOUR HOME

Single Family Home Apartment

How long at present address?

Rent Own

Monthly mortgage payment or rent? $

No. of bedrooms:

Will the minor(s) have their own room? Yes No

If shared, with whom?

Name:

Age:

Do you have any guns or other weapons stored on the property? Yes No

If yes, what type of weapon(s)?

Where and how are they stored?

Who cares for the minor(s) if adults are employed outside of the home?

OTHER CHILDREN LIVING IN YOUR HOME UNDER THE AGE OF 18 (ATTACH ADDITIONAL PAGE IF NECESSARY)

Name

Relationship to

you

Date of Birth

Place of Birth

Grade Level

Developmental Disabilities

OTHER ADULTS LIVING IN YOUR HOME OVER THE AGE OF 18

(INCLUDING YOUR SPOUSE)

Name

Driver’s License

Social Security

Number

Date of Birth

Relationship

to you

Child

Protective

Services History

(Yes/No)

Criminal

History

(Yes/No)

Does any adult in the home have any problem(s) that could affect the minor(s), such as a history of child

abuse/molestation, violent behavior, or an alcohol or drug problem? Yes No

If yes, explain:

Mark whether you are related or not related to the

child. If you are related, how are you related?

Fill out your information, and

answer the questions about

your home.

List all of the children under 18

living in the home.

List all adults (18 or older) living in the home.

Local Court Form (Rev. 6-28-2016)

SB18074

CONFIDENTIAL GUARDIANSHIP QUESTIONNAIRE AND

AUTHORIZATION FOR RELEASE OF INFORMATION

Page 3 of 7

Probate Code § 1513

Have the police ever been to your home? Yes No

If yes, explain when and why (attach additional page if necessary):

EMPLOYMENT / INCOME

Are you employed? Yes No

Name of Employer:

Telephone Number:

Address of Employer:

Length of Employment:

Job Title:

Last Grade Completed and Special Training:

Gross Monthly Income:

Income from other sources (retirement, SSI, etc.):

YOUR HEALTH CONDITION

(List any prior and/or current physical or mental health problems)

Present health status: Good Fair Poor

If Fair or Poor, please explain:

Have you ever been treated for or do you now have a physical impairment (e.g. hearing loss)? Yes No

If yes, explain in detail, including medications, hospitalizations, and therapy/counseling (when and where):

What, if any medications are you currently taking and what are they are for?

Do you have a history of mental health issues/impairments? Yes No If yes, explain:

Have you ever been in counseling?

Yes No

If yes, when?

If yes, what was/is the reason?

Drugs

Alcohol

Grief

Domestic Violence

Other

Explain:

CRIMINAL BACKGROUND

Were you ever arrested for an offense other than a minor traffic violation?

Yes

If yes, give date, place and details of offense (attach additional page if necessary):

Have you had previous involvement with Child Protective Services?

Yes

If yes, explain the circumstances in detail and include dates and name of County or State where involvement occurred

(attach an additional page if necessary):

Are you currently on Probation? Yes No

Officer’s Name:

If yes, explain:

Are you currently on Parole? Yes No

Officer’s Name:

If yes, explain:

Answer each question completely.

Answer all of the questions. Do not

put "n/a." Write "none" if there is

none.

Local Court Form (Rev. 6-28-2016)

SB18074

CONFIDENTIAL GUARDIANSHIP QUESTIONNAIRE AND

AUTHORIZATION FOR RELEASE OF INFORMATION

Page 4 of 7

Probate Code § 1513

MARRIAGES

Indicate if you are:

Married Widowed Single Separated Divorced Registered Domestic Partner

If currently married or separated, what is your spouse’s name?

Date of most recent marriage:

Number of children from this marriage:

Ages of children:

Previous marriages:

Name of former spouses:

How were previous marriages terminated (i.e., divorce or death)?

Number of children from previous marriages:

Ages of children:

SPOUSE INFORMATION (Complete only if spouse is not a proposed guardian and is, therefore, not required to complete a

separate questionnaire)

Full name:

Maiden name (if applicable):

Aliases:

Language(s) spoken (including sign language):

Race/Ethnicity:

Age:

Date of Birth:

Place of Birth:

Social Security Number:

Driver’s License Number:

Telephone Number ( TDD):

Mobile Phone Number:

Employer Name:

Employer Phone Number:

Employer Address:

Job Title:

Present health status: Good Fair Poor

Does your spouse take any medication? Yes No

Does your spouse have any special health problems? Yes No

Does your spouse have any mental/emotional problems? Yes No

Has your spouse ever used drugs or alcohol? Yes No

Have charges ever been filed against your spouse for crimes other than minor traffic citations? Yes No

Is your spouse on parole or probation? Yes No

If yes, parole or probation officer’s name:

Phone Number:

Has your spouse had previous involvement with Child Protective Services? Yes No

INFORMATION ABOUT THE MINOR(S) NEEDING GUARDIANSHIP (ATTACH ADDITIONAL PAGE IF NECESSARY)

Minor 1

Name:

Age:

Ethnicity:

Date of Birth:

Place of Birth:

Date placed with petitioner:

Relationship to Petitioner:

Name of school:

Telephone:

Grade Level:

Teacher’s Name:

Name of physician caring for minor:

Telephone:

Address of Physician:

Describe known medical needs, mental health needs, and/or other special needs:

Answer each question completely.

Local Court Form (Rev. 6-28-2016)

SB18074

CONFIDENTIAL GUARDIANSHIP QUESTIONNAIRE AND

AUTHORIZATION FOR RELEASE OF INFORMATION

Page 5 of 7

Probate Code § 1513

How do you plan to meet the minor’s medical, mental health, and/or special needs?

Does the minor have a social worker?

Yes No

If yes, who is the social worker?

Telephone Number:

Is there a custody or visitation order for the minor?

Yes No

Don’t Know

Date of the order:

Case Number:

Where did the proceeding take place? County:

State:

Minor 2

Not applicable

Name:

Age:

Ethnicity:

Date of Birth:

Place of Birth:

Date placed with petitioner:

Relationship to Petitioner

Name of school:

Telephone:

Grade Level:

Teacher’s Name:

Name of physician caring for minor:

Telephone:

Address of Physician:

Describe known medical needs, mental health needs, and/or other special needs:

How do you plan to meet the minor’s medical, mental health, and/or special needs?

Does the minor have a social worker?

Yes

If yes, who is the social worker?

Telephone Number:

Is there a custody or visitation order for the minor?

Yes No

Don’t Know

Date of the order:

Case Number:

Where did the proceeding take place? County:

State:

Minor 3

Not applicable

Name:

Age:

Ethnicity:

Date of Birth:

Place of Birth:

Date placed with petitioner:

Relationship to Petitioner

Name of school:

Telephone:

Grade Level:

Teacher’s Name:

Name of physician caring for minor:

Telephone:

Address of Physician:

Describe known medical needs, mental health needs, and/or other special needs:

How do you plan to meet the minor’s medical, mental health, and/or special needs?

Does the minor have a social worker?

Yes

If yes, who is the social worker?

Telephone Number:

Is there a custody or visitation order for the minor?

Yes

Don’t Know

Date of the order:

Case Number:

Where did the proceeding take place? (County)

(State)

Answer each question completely.

Mark Not Applicable if there is

only one child.

Local Court Form (Rev. 6-28-2016)

SB18074

CONFIDENTIAL GUARDIANSHIP QUESTIONNAIRE AND

AUTHORIZATION FOR RELEASE OF INFORMATION

Page 6 of 7

Probate Code § 1513

Minor 4

Not applicable

Name:

Age:

Ethnicity:

Date of Birth:

Place of Birth:

Date placed with petitioner:

Relationship to Petitioner

Name of school:

Telephone:

Grade Level:

Teacher’s Name:

Name of physician caring for minor:

Telephone:

Address of Physician:

Describe known medical needs, mental health needs, and/or other special needs:

How do you plan to meet the minor’s medical, mental health, and/or special needs?

Does the minor have a social worker?

Yes No

If yes, who is the social worker?

Telephone Number:

Is there a custody or visitation order for the minor?

Yes

Don’t Know

Date of the order:

Case Number:

Where did the proceeding take place? County:

State:

Minor 5

Not applicable

Name:

Age:

Ethnicity:

Date of Birth:

Place of Birth:

Date placed with petitioner:

Relationship to Petitioner

Name of school:

Telephone:

Grade Level:

Teacher’s Name:

Name of physician caring for minor:

Telephone:

Address of Physician:

Describe known medical needs, mental health needs, and/or other special needs:

How do you plan to meet the minor’s medical, mental health, and/or special needs?

Does the minor have a social worker?

Yes No

If yes, who is the social worker?

Telephone Number:

Is there a custody or visitation order for the minor?

Yes No

Don’t Know

Date of the order:

Case Number:

Where did the proceeding take place? County:

State:

REFERENCES

Provide (2) non-related references who have knowledge of your home life and standing in the community.

NAME ADDRESS

TELEPHONE

NUMBER

OCCUPATION

Answer each question completely.

Mark Not Applicable if there is

only one child.

You must provide 2 non-related references.

Local Court Form (Rev. 6-28-2016)

SB18074

CONFIDENTIAL GUARDIANSHIP QUESTIONNAIRE AND

AUTHORIZATION FOR RELEASE OF INFORMATION

Page 7 of 7

Probate Code § 1513

BIRTH PARENTS

Mother’s Name:

Date of Birth:

Telephone:

Address:

Last contact with minor(s):

Father’s Name:

Date of Birth:

Telephone:

Address:

Last contact with minor(s):

What is the relationship between Petitioner and birth parents? (visitation schedule, areas of conflict or disagreement)?

How long do you expect this guardianship to last?

What are the long term plans for the minor(s)?

Is the birth mother in agreement with guardianship?

Yes

Unknown

Comments:

Is the birth father in agreement with guardianship?

Yes No Unknown

Comments:

Have the birth parents made you aware of their plans for the minor(s)?

Yes

If yes, describe known plans:

I declare under penalty of perjury under the laws of the State of California that the foregoing is

true and correct

Date:

____________________________________________________ ________________________________________________

TYPE OR PRINT NAME OF PROPOSED GUARDIAN OR APPLICANT SIGNATURE OF PROPOSED GUARDIAN OR APPLICANT

Answer each question completely.

Provide as much information about the

children's birth parents as possible.

Print date

Name of proposed guardian

Signature of proposed guardian

TELEPHONE NO.:

DUTIES OF GUARDIAN

When you are appointed by the court as a guardian of a minor, you become an officer of the court and assume certain

duties and obligations. An attorney is best qualified to advise you about these matters. You should clearly understand the

information on this form. You will find additional information in the Guardianship Pamphlet (for Guardianships of Children

in the Probate Court) (Form GC-205), which is available from the court.

1. GUARDIANSHIP OF THE PERSON

If the probate court appoints you as a guardian of the person for a child, you will be required to assume important

duties and obligations.

a. Fundamental responsibilities - The guardian of the person of a child has the care, custody, and control of

the child. As guardian, you are responsible for providing for food, clothing, shelter, education, and all the

medical and dental needs of the child. You must provide for the safety, protection, and physical and emotional

growth of the child.

Custody - As guardian of the person of the child, you have full legal and physical custody of the child and are

responsible for all decisions relating to the child. The child's parents can no longer make decisions for the

child while there is a guardianship. The parents' rights are suspended—not terminated—as long as a guardian

is appointed for a minor.

Education - As guardian of the person of the child, you are responsible for the child's education. You

determine where the child should attend school. As the child's advocate within the school system, you should

attend conferences and play an active role in the child's education. For younger children, you may want to

consider enrolling the child in Head Start or other similar programs. For older children, you should consider

their future educational needs such as college or a specialized school. You must assist the child in obtaining

services if the child has special educational needs. You should help the child in setting and attaining his or her

educational goals.

Residence - As guardian, you have the right to determine where the child lives. The child will normally live

with you, but when it is necessary, you are allowed to make other arrangements if it is in the best interest of

the child. You should obtain court approval before placing the child back with his or her parents.

As guardian, you do not have the right to change the child's residence to a place outside of California unless

you first receive the court's permission. If the court grants permission, California law requires that you

establish legal guardianship in the state where the child will be living. Individual states have different rules

regarding guardianships. You should seek additional information about guardianships in the state where you

want the child to live.

DUTIES OF GUARDIAN

(Probate)

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address):

FOR COURT USE ONLY

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

GUARDIANSHIP OF THE

CASE NUMBER:

DUTIES OF GUARDIAN

and Acknowledgment of Receipt

GC-248

MINOR

PERSON ESTATE

OF (Name):

Form Adopted for Mandatory Use

Judicial Council of California

GC-248 [New January 1, 2001]

Page one of five

(Continued on reverse)

ATTORNEY FOR (Name):

FAX NO. (Optional):

E–MAIL ADDRESS (Optional):

Name & Address and phone number of

Proposed Guardian(s)

247 W. Third St.

San Bernardino, CA 92415

Probate Division

✔

List all children for whom you need guardianship

GUARDIAN OF (Name): CASE NUMBER:

MINOR

e. Medical treatment - As guardian, you are responsible for meeting the medical needs of the child. In most

cases, you have the authority to consent to the child's medical treatment. However, if the child is 14 years or

older, surgery may not be performed on the child unless either (1) both the child and the guardian consent or

(2) a court order is obtained that specifically authorizes the surgery. This holds true except in emergencies. A

guardian may not place a child involuntarily in a mental health treatment facility under a probate guardianship.

A mental health conservatorship proceeding is required for such an involuntary commitment. However, the

guardian may secure counseling and other necessary mental health services for the child. The law also

allows older and more mature children to consent to their own treatment in certain situations such as

outpatient mental health treatment, medical care related to pregnancy or sexually transmitted diseases, and

drug and alcohol treatment.

f. Community resources - There are agencies in each county that may be helpful in meeting the specific

needs of children who come from conflicted, troubled, or deprived environments. If the child has special

needs, you must strive to meet those needs or secure appropriate services.

g. Financial support - Even when the child has a guardian, the parents are still obligated to financially support

the child. The guardian may take action to obtain child support. The child may also be eligible for Temporary

Aid for Needy Families, TANF (formerly known as AFDC), social security benefits, Veterans Administration

benefits, Indian child welfare benefits, and other public or private funds.

h. Visitation - The court may require that you allow visitation or contact between the child and his or her

parents. The child's needs often require that the parent-child relationship be maintained, within reason.

However, the court may place restrictions on the visits, such as the requirement of supervision. The court

may also impose other conditions in the child's best interest.

Driver's license - As guardian of the person, you have the authority to consent to the minor's application for

a driver's license. If you consent, you will become liable for any civil damages that may result if the minor

causes an accident. The law requires that anyone signing the DMV application obtain insurance to cover the

minor.

Enlistment in the armed services - The guardian may consent to a minor's enlistment in the armed

services. If the minor enters into active duty with the armed forces, the minor becomes emancipated under

California law.

Marriage - For the minor to marry, the guardian and the court must give permission. If the minor enters a

valid marriage, the minor becomes emancipated under California law.

Change of address - A guardian must notify the court in writing of any change in the address of either the

child or the guardian. This includes any changes that result from the child's leaving the guardian's home or

returning to the parent's home. You must always obtain court permission before you move the child to

another state or country.

Court visitors and status reports - Some counties have a program in which ''court visitors'' track and review

guardianships. If your county has such a program, you will be expected to cooperate with all requests of the

court visitor. As guardian, you may also be required to fill out and file status reports. In all counties, you must

cooperate with the court and court investigators.

Misconduct of the child - A guardian, like a parent, is liable for the harm and damages caused by the willful

misconduct of a child. There are special rules concerning harm caused by the use of a firearm. If you are

concerned about your possible liability, you should consult an attorney.

Additional responsibilities - The court may place other conditions on the guardianship or additional duties

upon you, as guardian. For example, the court may require the guardian to complete counseling or parenting

classes, to obtain specific services for the child, or to follow a scheduled visitation plan between the child and

the child's parents or relatives. As guardian, you must follow all court orders.

GC-248 [New January 1, 2001 ]

DUTIES OF GUARDIAN

(Probate)

Page two of five

(Continued on page three)

GC-248

List all children for whom you need guardianship

GUARDIAN OF (Name): CASE NUMBER:

MINOR

p. Termination of guardianship of the person - A guardianship of the person automatically ends when the

child reaches the age of 18, is adopted, marries, is emancipated by court order, enters into active military duty,

or dies. If none of these events has occurred, the child, a parent, or the guardian may petition the court for

termination of guardianship. But it must be shown that the guardianship is no longer necessary or that

termination of the guardianship is in the child's best interest.

2. GUARDIANSHIP OF THE ESTATE

If the court appoints you as guardian of the child's estate, you will have additional duties and obligations. The

money and other assets of the child are called the child's ''estate."' Appointment as guardian of a child's estate

is taken very seriously by the court. The guardian of the estate is required to manage the child's funds, collect

and make an inventory of the assets, keep accurate financial records, and regularly file financial accountings

with the court.

MANAGING THE ESTATE

Prudent investments - As guardian of the estate, you must manage the child's assets with the care of a

prudent person dealing with someone else's property. This means that you must be cautious and may not

make speculative or risky investments.

Keeping estate assets separate - As guardian of the estate, you must keep the money and property of the

child's estate separate from everyone else's, including your own. When you open a bank account for the

estate, the account name must indicate that it is a guardianship account and not your personal account. You

should use the child's social security number when opening estate accounts. You should never deposit estate

funds in your personal account or otherwise mix them with your own funds or anyone else's funds, even for

brief periods. Securities in the estate must be held in a name that shows that they are estate property and not

your personal property.

Interest-bearing accounts and other investments - Except for checking accounts intended for ordinary

expenses, you should place estate funds in interest-bearing accounts. You may deposit estate funds in

insured accounts in federally insured financial institutions, but you should not put more than $100,000 in any

single institution. You should consult with an attorney before making other kinds of investments.

d. Blocked accounts - A blocked account is an account with a financial institution in which money is placed. No

person may withdraw funds from a blocked account without the court's permission. Depending on the amount

and character of the child's property, the guardian may elect or the court may require that estate assets be

placed in a blocked account. As guardian of the estate, you must follow the directions of the court and the

procedures required to deposit funds in this type of account. The use of a blocked account is a safeguard and

may save the estate the cost of a bond.

Other restrictions - As guardian of the estate, you will have many other restrictions on your authority to deal

with estate assets. Without prior court order, you may not pay fees to yourself or your attorney. You may not

make a gift of estate assets to anyone. You may not borrow money from the estate. As guardian, you may not

use estate funds to purchase real property without a prior court order. If you do not obtain the court's

permission to spend estate funds, you may be compelled to reimburse the estate from your own personal

funds and may be removed as guardian. You should consult with an attorney concerning the legal

requirements relating to sales, leases, mortgages, and investment of estate property. If the child of whose

estate you are the guardian has a living parent or if that child receives assets or is entitled to support from

another source, you must obtain court approval before using guardianship assets for the child's support,

maintenance, or education. You must file a petition or include a request for approval in the original petition,

and set forth which exceptional circumstances justify any use of guardianship assets for the child's support.

The court will ordinarily grant such a petition for only a limited period of time, usually not to exceed one year,

and only for specific and limited purposes.

INVENTORY OF ESTATE PROPERTY

f. Locate the estate's property - As guardian of the estate, you must locate, take possession of, and protect

the child's income and assets that will be administered in the estate. You must change the ownership of all

assets into the guardianship estate's name. For real estate, you should record a copy of your Letters of

Guardianship with the county recorder in each county where the child owns real property.

GC-248 [New January 1, 2001 ]

DUTIES OF GUARDIAN

(Probate)

Page three of five

(Continued on reverse)

GC-248

List all children for whom you need guardianship

g. Determine the value of the property - As guardian of the estate, you must arrange to have a court-appointed

referee determine the value of the estate property unless the appointment is waived by the court. You—not the

referee—must determine the value of certain ''cash items.'' An attorney can advise you about how to do this.

File an inventory and appraisal - As guardian of the estate, you must file an inventory and appraisal within

90 days after your appointment. You may be required to return to court 90 days after your appointment as

guardian of the estate to ensure that you have properly filed the inventory and appraisal.

INSURANCE

Insurance coverage - As guardian of the estate, you should make sure that there is appropriate and sufficient

insurance covering the assets and risks of the estate. You should maintain the insurance in force throughout

the entire period of the guardianship or until the insured asset is sold.

RECORD KEEPING AND ACCOUNTING

Records - As guardian of the estate, you must keep complete, accurate records of each financial transaction

affecting the estate. The checkbook for the guardianship checking account is essential for keeping records of

income and expenditures. You should also keep receipts for all purchases. Record keeping is critical because

you will have to prepare an accounting of all money and property that you have received, what you have

spent, the date of each transaction, and its purpose. You will also have to be able to describe in detail what is

left after you have paid the estate's expenses.

Accountings - As guardian of the estate, you must file a petition requesting that the court review and approve

your accounting one year after your appointment and at least every two years after that. The court may ask

that you justify some or all expenditures. You should have receipts and other documents available for the

court's review, if requested. If you do not file your accounting as required, the court will order you to do so. You

may be removed as guardian for failure to file an accounting.

Format - As guardian of the estate, you must comply with all state and local rules when filing your accounting.

A particular format is specified in the Probate Code, which you must follow when you present your account to

the court. You should check local rules for any special local requirements.

Legal advice - An attorney can advise you and help you prepare your inventories, accountings, and petitions

to the court. If you have questions, you should consult with an attorney.

3. OTHER GENERAL INFORMATION

Removal of a guardian - A guardian may be removed for specific reasons or when it is in the child's best

interest. A guardian may be removed either on the court's own motion or by a petition filed by the child, a

relative of the child, or any other interested person. If necessary, the court may appoint a successor guardian,

or the court may return the child to a parent if that is found to be in the child's best interest.

Legal documents - For your appointment as guardian to be valid, the Order Appointing Guardian of Minor

must be signed. Once the court signs the order, the guardian must go to the clerk's office, where Letters of

Guardianship will be issued. Letters of Guardianship is a legal document that provides proof that you have

been appointed and are serving as the guardian of a minor. You should obtain several certified copies of the

Letters from the clerk. These legal documents will be of assistance to you in the performance of your duties,

such as enrolling the child in school, obtaining medical care, and taking care of estate business.

Attorneys and legal resources - If you have an attorney, the attorney will advise you on your duties and

responsibilities, the limits of your authority, the rights of the child, and your dealings with the court. If you have

legal questions, you should consult with your attorney. Please remember that the court staff cannot

give you legal advice.

Page four of five

GC-248 [New January 1, 2001 ]

DUTIES OF GUARDIAN

(Probate)

GUARDIAN OF (Name): CASE NUMBER:

MINOR

(Continued on page five)

GC-248

List all children for whom you need guardianship

GUARDIAN OF (Name): CASE NUMBER:

MINOR

If you are not represented by an attorney, you may obtain answers to your questions by contacting

community resources, private publications, or your local law library.

NOTICE: This statement of duties is a summary and is not a complete statement of the law. Your conduct

as a probate guardian is governed by the law itself and not by this summary.

ACKNOWLEDGMENT OF RECEIPT

I acknowledge that I have received a copy of this statement of the duties of the position of guardian.

I have petitioned the court to be appointed as a guardian.1.

Page five of five

GC-248 [New January 1, 2001 ]

DUTIES OF GUARDIAN

(Probate)

Date:

(TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER)

Date:

(TYPE OR PRINT NAME)

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF PETITIONER)

GC-248

List all children for whom you need guardianship

Print the date signed

Name of 1st Petitioner

1st Petitioner signs

Print the date signed

Name of 2nd Petitioner

2nd Petitioner signs

Person child lived with (name and complete current address)

Additional children are listed on form FL-105(A)/GC-120(A). (Provide all requested information for additional children.)

FL-105/GC-120

FOR COURT USE ONLY

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

CASE NUMBER:

DECLARATION UNDER UNIFORM CHILD CUSTODY

JURISDICTION AND ENFORCEMENT ACT (UCCJEA)

1. I am a party to this proceeding to determine custody of a child.

2. My present address and the present address of each child residing with me is confidential under Family Code section 3429 as

I have indicated in item 3.

3. There are (specify number):

(Insert the information requested below. The residence information must be given for the last FIVE years.)

a. Child’s name

Place of birth Date of birth Sex

Period of residence

Address

Relationship

Confidentialto present

b. Child’s name

Place of birth Date of birth Sex

Residence information is the same as given above for child a.

(If NOT the same, provide the information below.)

Period of residence

Address

Relationship

Confidential

to present

Additional residence information for a child listed in item a or b is continued on attachment 3c.

Page 1 of 2

Family Code, § 3400 et seq.; Form Adopted for Mandatory Use

Judicial Council of California

FL-105/GC-120 [Rev. January 1, 2009]

DECLARATION UNDER UNIFORM CHILD CUSTODY

JURISDICTION AND ENFORCEMENT ACT (UCCJEA)

Probate Code, §§ 1510(f), 1512

minor children who are subject to this proceeding, as follows:

www.courtinfo.ca.gov

TELEPHONE NO.:

FAX NO. (Optional):

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

PETITIONER:

RESPONDENT:

GUARDIANSHIP OF (Name):

Minor

OTHER PARTY:

Child's residence (City, State)

(This section applies only to family law cases.)

(This section apples only to guardianship cases.)

Confidential

Name & Address and phone number of

Proposed Guardian(s)

247 W. Third St.

San Bernardino, CA 92415

Probate Division

List all children for whom you need guardianship

Number of Children

Fill-in Information Regarding the Child(ren).

State where the Child(ren) lived during the Past

5 years.

Start with the current address and work back to

cover 5 years.

Fill-in the information about the second

child. Mark this box if your children

always lived together. If not, list the

residence history for the second child.

Juvenile Delinquency/

Juvenile Dependency

and provide the following information):

5. One or more domestic violence restraining/protective orders are now in effect. (Attach a copy of the orders if you have one

a. Criminal

b. Family

d. Other

Court State Case number (if known) County Orders expire (date)

Court

(name, state, location)

Court order

or judgment

(date)

Case status

b. Guardianship

c. Other

Name of each child

a. Family

Case number

Court (name, state, location)

e. Adoption

Juvenile Delinquency/

Juvenile Dependency

Case Number

Your

connection to

the case

CASE NUMBER:

SHORT TITLE:

Do you have information about, or have you participated as a party or as a witness or in some other capacity in, another court case

or custody or visitation proceeding, in California or elsewhere, concerning a child subject to this proceeding?

Yes

(If yes, attach a copy of the orders (if you have one) and provide the following information):

Do you know of any person who is not a party to this proceeding who has physical custody or claims to have custody of or

visitation rights with any child in this case?

(If yes, provide the following information):Yes

a. Name and address of person

b. Name and address of person

c. Name and address of person

Has physical custody

Claims custody rights

Claims visitation rights

Name of each child Name of each child Name of each child

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

7. Number of pages attached:

NOTICE TO DECLARANT: You have a continuing duty to inform this court if you obtain any information about a custody

FL-105/GC-120 [Rev. January 1, 2009]

Page 2 of 2

DECLARATION UNDER UNIFORM CHILD CUSTODY

JURISDICTION AND ENFORCEMENT ACT (UCCJEA)

proceeding in a California court or any other court concerning a child subject to this proceeding.

FL-105/GC-120

Proceeding

List all children for whom you need guardianship

Has the Child(ren) ever been the subject

of any other court case? If so, give

information regarding that case.

If there is a restraining/protective order

between you and the other party, mark box

5 and provide information about that case.

Answer Question 6. If "yes", fill in the

information about that person and the

child's name.

Print the date signed

Print the petitioner(s) names

All Petitioners sign here

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

BRANCH NAME:

CITY AND ZIP CODE:

STREET ADDRESS:

MAILING ADDRESS:

(name):

GUARDIANSHIP OF

FOR COURT USE ONLY

CASE NUMBER:

LETTERS OF GUARDIANSHIP

EstatePerson

GC-250

ATTORNEY OR PARTY WITHOUT ATTORNEY

STATE: ZIP CODE:CITY:

STREET ADDRESS:

FIRM NAME:

NAME:

STATE BAR NO.:

TELEPHONE NO.: FAX NO.:

E-MAIL ADDRESS:

ATTORNEY FOR (name):

LETTERS

(Name):

is appointed guardian of the person

estate

of (name):

The appointment of

(name):

as guardian of the person of

(name):

is extended past the ward's 18th birthday as of (date):

Other powers have been granted and conditions have been imposed as follows:

Powers to be exercised independently under Probate Code section 2590 are specified in attachment 3a (specify

powers, restrictions, conditions, and limitations).

Conditions relating to the care and custody of the property under Probate Code section 2402 are specified in

attachment 3b.

Conditions relating to the care, treatment, education, and welfare of the ward under Probate Code section 2358 are

specified in attachment 3c.

Other powers granted or conditions imposed are specified on attachment 3d specified below.

WITNESS, clerk of the court, with seal of the court affixed.

Number of pages attached:

Date:

Clerk, by

, Deputy

(SEAL)

Page 1 of 2

Form Adopted for Mandatory Use

Judicial Council of California

GC-250 [Rev. July 1, 2016]

LETTERS OF GUARDIANSHIP

(Probate—Guardianships and Conservatorships)

Probate Code, §§ 2310, 2311, 2890–2893

www.courts.ca.gov

The guardianship of the person terminates by operation of law on (date):

The guardian is not authorized to take possession of money or any other property without a specific court order.

Name & Address and phone number

of Proposed Guardian(s)

247 W. Third St.

San Bernardino, CA 92415

Probate Division

List all children for whom you need guardianship

✔

Name of proposed guardian(s)

Name of each child

✔

Guardians shall be allowed to apply for and receive public benefits and social

security benefits for the minor children.

✔

(usually 0)

GC-250

CASE NUMBER:

(name):

GUARDIANSHIP OF

NOTICE TO INSTITUTIONS AND FINANCIAL INSTITUTIONS

(Probate Code sections 2890–2893)

When these Letters of Guardianship (Letters) are delivered to you as an employee or other representative of an institution or

financial institution (described below) in order for the guardian of the estate (1) to take possession or control of an asset of the minor

named above held by your institution (including changing title, withdrawing all or any portion of the asset, or transferring all or any

portion of the asset) or (2) to open or change the name of an account or a safe-deposit box in your financial institution to reflect the

guardianship, you must fill out Judicial Council form GC-050 (for an institution) or form GC-051 (for a financial institution). An officer

authorized by your institution or financial institution must date and sign the form, and you must file the completed form with the court.

There is no filing fee for filing the form. You may either arrange for personal delivery of the form or mail it to the court for filing at the

address given for the court on page 1 of these Letters.

The guardian should deliver a blank copy of the appropriate form to you with these Letters, but it is your institution’s or financial

institution’s responsibility to complete the correct form, have an authorized officer sign it, and file the completed form with the court. If

the correct form is not delivered with these Letters or is unavailable for any other reason, blank copies of the forms may be obtained

from the court. The forms may also be accessed from the judicial branch’s public website free of charge. The Internet address (URL) is

www.courts.ca.gov/forms.htm. Select the form group Probate—Guardianships and Conservatorships and scroll down to form GC-050

for an institution or form GC-051 for a financial institution. The forms may be printed out as blank forms and filled in by typewriter

(nonfillable form) or may be filled out online and printed out ready for signature and filing (fillable form).