Gc 212 Form – Fill Out and Use This PDF

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

FOR COURT USE ONLY

TELEPHONE NO.:

FAX NO. (Optional):

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

GUARDIANSHIP OF

CASE NUMBER:

(Name):

MINOR

CONFIDENTIAL GUARDIAN SCREENING FORM

HEARING DATE AND TIME:

DEPT.:

Guardianship of

Person

Estate

b.

Date of birth:

c.

Social security number:

d. Driver's license number:

State:

e.

Telephone numbers: Home:

Work:

Other:

Yes

No

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

11.

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

Yes

No

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

12.

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

No

Yes

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

13.

I have or may have

I do not have

an adverse interest that the court may consider to be a risk to, or to have an

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

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

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.)

16.

I am

I am not

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.)

17.

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

I am

I am not

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.)

18.

I am

I am not

a responsible corporate officer authorized to act for (name of corporation):

,

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.)

19.

I have

I have not

filed for bankruptcy protection within the last 10 years.

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

MINORS' CONTACT INFORMATION

20.

Minor's name:

School (name):

Home telephone:

School telephone:

Other telephone:

21.

Minor's name:

School (name):

Home telephone:

School telephone:

Other telephone:

22.

Minor's name:

School (name):

Home telephone:

School telephone:

Other telephone:

Information on additional minors is attached.

DECLARATION

(TYPE OR PRINT NAME OF PROPOSED GUARDIAN)

(SIGNATURE OF PROPOSED GUARDIAN)*