Fill and Sign the Justia Petition to Appoint a Custodial Guardian for a Form

PMG70C – Petition to Appoint Custodial Guardian for a Minor (08/2014 ) Page 1 of 5 STATE OF VERMONT SUPERIOR COURT PROBATE DIVISION Unit Docket No .: In re Guardianship of : PETITION TO APPOINT CUSTODIAL GUARDIAN FOR A MINOR I ask the court to appoint a guardian for the minor child , In support of this request, I state under oath: 1. Reason for Guardianship The minor is a child in need of guardianship for the following reasons: (check all that apply) ☐ No parent objects and the transfer of custody is in the best interest of the minor and is not solely for the purpose of establishing a residence for school purposes. ☐ One or both parents are under guardianship. ☐ One or both parents are incompetent or unsuitable to have custody of the minor. ☐ The minor has no living parent authorized to act as guardian. ☐ The parent of the minor resides outside the state and has so resided for three years and has not contributed to the minor’s support during that time, and the minor has resided in the state three years prior to the date of appointment . Describe the specific reasons why a guardianship is necessary: 2. Information about the Minor: (You must provide the Court with a copy of the child’s birth certific ate when you file the petition.) Name of Minor DOB Age Grade Current Address where Minor resides Town State Zip Current Mailing Address if different Phone Number 3. During the last five (5) years the minor has res ided at the following addresses: (Begin with the address listed above. List all household members .) Address Include Street, City/Town and State Dates From When to When Names of all persons residing in the household with the child 4. Is the child: A member of a federally recognized Indian tribe? ☐ Yes ☐ No Eligible for membership in a federally recognized Indian tribe and the biological child of a member of an Indian tribe? ☐ Yes ☐ No PMG70C – Petition to Appoint Custodial Guardian for a Minor (08/2014 ) Page 2 of 5 5. Is the child in school? ☐ Yes ☐ No If yes, indicate the name and location of the school : The child’s current grade level is: 6. Information about the parents of the minor ( If either parent is deceased, you must provide a copy of the death certificate.) a. Name of Parent #1 DOB Deceased ☐ Yes ☐ No Age Mailing Address for Parent #1 Town State Zip Residential Address if different Town Phone Number b. Name of Parent #2 DOB Deceased ☐ Yes ☐ No Age Mailing Address for Parent #2 Town State Zip Residential Address if different Town Phone Number c. If you cannot provide a valid name and/or address for one or both parents, please describe in detail the efforts that have been made to locate the parent or parents. If the identity of the father is unknown, provide all of the information you can abou t potential fathers and any prior paternity proceedings. d. Parents’ Position Regarding Guardianship Parent #1 is in agreement with guardianship for minor: ☐ Yes ☐ No ☐ Don’t Know Parent #2 is in agreement with guardianship for minor: ☐ Yes ☐ No ☐ Don’t Know 7. Status of Legal Custody of Minor a. The following person or person(s) currently has/have parental rights and responsibilities (legal custody) for the minor: Name(s) Relationship to Minor Mailing Address Legal custody was granted by a court? ☐ Yes ☐ No Name and address of court b. There is a pending proceeding involving custody, parental rights and responsibilities or paren t child contact (visitation): ☐ Yes ☐ No If yes, provide the name and address of the court and the docket number of the case: PMG70C – Petition to Appoint Custodial Guardian for a Minor (08/2014 ) Page 3 of 5 PLEASE PROVIDE COPIES OF ANY COURT ORDERS WITH YOUR FILING 8. Other legal proceedings involving the minor child, parent or proposed guardian (check all that apply. For each proceeding, check the person or persons involved in the proceeding) ☐ Juvenile delinquency ☐ minor ☐ parent ☐ guardian ☐ CHINS (Child in Need of Care or Supervision) Abuse/Neglect or Unmanageable ☐ minor ☐ parent ☐ guardian ☐ Domestic Violence (relief fr om abuse or restraining order) ☐ minor ☐ parent ☐ guardian ☐ Divorce ☐ minor ☐ parent ☐ guardian ☐ Paternity ☐ minor ☐ parent ☐ guardian ☐ Adoption ☐ minor ☐ parent ☐ guardian ☐ Conviction for a crime ☐ minor ☐ parent ☐ guardian ☐ Other Court proceeding ☐ minor ☐ parent ☐ guardian Specify type of proceeding: 9. Is DCF (Department for Children and Famil ies) involved with this child? ☐ Yes ☐ No If yes, provide the name of the DCF social worker, if known: 10. Is there an existing child support order for this child? ☐ Yes ☐ No If the guardianship is approved, does the proposed guardian expect to receive child support or fin ancial benefits for the child? ☐ Yes ☐ No 11. Is the child a recipien t of social security benefits? ☐ Yes ☐ No If yes, provide the name of the representative payee, if known: 12. Is there an existing parent child contact (visitation) order that affects the child? ☐ Yes ☐ No If yes, either attach a copy of the most recent court order or provide information about the order including the schedule of contact, the name of the person entitled to contact and whether the contact currently takes place : 13. Is there any reason why the child should not h ave contact with the parents? ☐ Yes ☐ No If yes, describe the reasons in detail : PMG70C – Petition to Appoint Custodial Guardian for a Minor (08/2014 ) Page 4 of 5 14. Information about Proposed Guardian and Co -Guardian, if any: Guardian Name of proposed guardian DOB Mailing Address Town Zip Phone Number Relationship between proposed guardian and minor child : Relative ☐ ☐Friend/Neighbor ☐Other If there is a proposed co -guardian, provide information below about that person Co -Guardian Name of proposed co -guardian DOB Mailing Address Town Zip Phone Number Relationship between proposed co -guardian and minor child ☐Relative ☐ Friend/Neighbor ☐ Other 15. List all persons residing in the proposed g uardian’s home and the relationship of those persons to the minor child: Name of Household Member Relationship to Child Add an additional page if necessary 16. Change of School Does the proposed guardian intend to change the child’ s school ? ☐ Yes ☐ No ☐ Don’t Know If yes, provide the name and address of the school the child will attend 17. Answer the following questions by checking the box if the statement is true. If your answer to any of the questions is yes , please explain your answer on an additional page. a. I have participated as a party, witness, or in some other way in a court case about the custody of this child either in Vermont or another state. ☐ Yes ☐ No b. I have information about a custody case concerning this child that is now pending in a Vermont court or a court in another state. ☐ Yes ☐ No c. I have knowledge about a person who is not a party to this case who has physical custody of this child or who claims to have custody or visitation rights to this child ☐ Yes ☐ No d. If you answered yes to any of the questions above, please explain: PMG70C – Petition to Appoint Custodial Guardian for a Minor (08/2014 ) Page 5 of 5 THEREFORE, I/we request that the court appoint a guardian for the minor child. By signing this petition, I/we certify that I/we have read the petition and that to the best of my/our knowledge, information and belief, the facts set forth in the petition are true and that the petition is not filed for any improper purpose such as to harass or cause unnecessary dela y or needless litigation. Date Signature of Petitioner Petitioner’s Mailing Address Petitioner’s Phone Number Subscribed and sworn before me on: Date My commission expires on: Date of Expiration Signature of Notary Attachments  Filing fee payable to the Vermont Superior Court, Probate Division  List of Interested Persons (Form PG73 )  A copy of the birth certificate of the minor child*  A consent to the guardianshi p signed by Parent #1 (Form PMG 70p)  A consent to the guardianshi p signed by Parent #2 (Form PMG 70p)  A consent to the guardianship signed by the proposed guardian (Form PMG 70g)  Copies of any court orders that currently affect the child  If eith er parent is deceased, a copy of the death certificate*  Guardian’s Consent to Background Check by DCF *Check with the probate court where you will file the petition to see if the court requires that birth certificates and de ath certificates be certified.