California Guardianship Petition

a. Child’s full legal name: Date of birth:

b. Child’s current address:

c. Is this child a member of, or eligible for membership in, one or more Indian tribes recognized by the federal government? No Not sure Yes

Do you know or have reason to know whether this child is or may be an Indian child? No Yes

d. Is this child married? Yes No Never married

If “No,” was this child formerly married but the marriage was dissolved or ended in divorce? Yes No

e. Is this child receiving public assistance? Yes No Unknown

If you checked “Yes,” fill out below:

TANF (Temporary Asst. for Needy Families): Social Security:

Dept. Veterans Affairs Benefits: Other (explain):

Other (explain):

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

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

h. Has this child been involved in an adoption, juvenile court, marriage dissolution (divorce), domestic relations, custody, or other similar court case?

i. Is this child in or on leave from an institution supervised by the California Department of Developmental Services or the California Department of Mental Health?

Father:

Mother:

Grandfather (Father’s father):

Grandmother (Father’s mother):

Grandfather (Mother’s father):

Grandmother (Mother’s mother):

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

Brother/Sister:

Brother/Sister:

Brother/Sister:

Brother/Sister:

Brother/Sister:

Brother/Sister:

Brother/Sister:

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

b. Relationship(s) to the child named in 1 (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 2

a. Father: Yes No Not known at this time

b. Mother: Yes No Not known at this time

a. Does this child live with the person in 3 now? Yes No

b. If the court approves the guardianship, will this child live with the person in 3? Yes No

c. Does the person in 3 plan to adopt this child now? Yes No

Check this box if you (the petitioner) are not the person in 3:

Your relationship to this child:

Relative (specify):

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

a. is not required; this is a guardianship of the estate only.

b. has not been made or completed for the following reasons:

Petitioner knows the child is an Indian child and has identified the child’s tribe or tribes in item 1.

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

c. An Indian child inquiry concerning the child named above has been made and the following information was obtained:

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):

The child has no known Indian ancestry.