Shylock Agreement Form PDF Details

Navigating through guardianship procedures can be a complex journey, filled with various forms and legal documents that must be meticulously completed and submitted. Among these, the Shylock Agreement form holds a vital place, particularly in the context of Stanislaus County Superior Court's procedures concerning guardianship cases. This form serves as a comprehensive questionnaire designed to gather extensive personal, financial, and background information from individuals seeking to become guardians. From detailing the proposed guardian's relationship to the minor and personal history, including addresses for the past five years and medical conditions, to probing into past criminal records, substance use, and financial stability, the form covers a broad spectrum of inquiries. It emphasizes the importance of transparency and thoroughness, as failing to complete and return this form with the Petition for Guardianship may lead to delays in the process. It also requires the attachment of crucial documents such as birth and, if applicable, death certificates of natural parents. By making it mandatory for proposed guardians to disclose detailed personal information and history, the form aims to safeguard the minor's interests and ensure they are placed in a safe, stable, and nurturing environment.

QuestionAnswer
Form NameShylock Agreement Form
Form Length12 pages
Fillable?No
Fillable fields0
Avg. time to fill out3 min
Other namesshylock loan agreement form, shylock agreement form pdf, shylock agrrements, shylock agreements

Form Preview Example

Stanislaus County Superior Court Investigator

GUARDIANSHIP QUESTIONNAIRE

Minor’s Name

 

Case No.

Proposed Guardian’s (Circle One) (Paternal or Maternal) relationship to minor

This form must be completed and returned with the Petition for Guardianship. If you find there is not enough room to complete your answer, use the space on the reverse of this form, clearly identifying the question. Do not leave any question blank. State N/A if the question does not apply to you. FAILURE TO COMPLETE AND RETURN THIS FORM WITH THE

PETITION WHEN SERVED ON THE INVESTIGATOR MAY RESULT IN DELAYS.

***ATTACH A COPY(IES) OF BIRTH CERTIFICATE(S) OF CHILD(REN) AND ANY DEATH CERTIFICATE(S) OF NATURAL PARENTS (if applicable).

PERSONAL HISTORY OF PETITIONER(S)

PROPOSED GUARDIAN #1

 

 

 

 

 

 

 

FULL NAME:

 

 

OTHER NAMES/MAIDEN

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth/Birth Place

 

 

 

CA ID/DL NO.

 

Social Security No.

 

 

 

 

 

 

 

 

List Addresses for Past Five Years

 

 

 

 

 

 

 

1.

 

 

 

 

 

 

 

 

 

 

 

 

Phone No. (

)

 

 

 

 

 

 

 

 

 

From

 

 

to

( ) Own ( ) Rent

 

Rent/Mortgage $

/Month

2.

 

 

 

 

 

 

 

 

 

 

 

 

Phone No. (

)

 

 

 

 

 

 

 

 

 

From

 

 

to

( ) Own ( ) Rent

 

Rent/Mortgage $

/Month

3.

 

 

 

 

 

 

 

 

 

 

 

 

Phone No. (

)

 

 

 

 

 

 

 

 

 

From

 

 

to

( ) Own ( ) Rent

 

Rent/Mortgage $

/Month

 

GR001

Page 1 of 12

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PROPOSED GUARDIAN #1 continued

Your Health (Circle)

Good

Fair

Poor

State Any Medical Conditions Currently Being Treated For:

Medications – Name, Amount, Reason, How Often Taken:

Attending Counseling? (Circle)

Yes No

Type:

 

Name of Counselor:

Have You Ever Been Convicted Of An Offense Other Than A Minor Traffic Violation?

(Circle) Yes No

If Yes, Please List Date:

 

City:

Outcome:

 

 

 

 

 

Have You Ever Been On Or Are You On Probation/Parole? (Circle) Yes

No

Officer/Agent’s Name:

 

 

County/Phone No.

 

 

Do You Drink Alcoholic Beverages? (Circle)

Yes No How Much/Often?

 

What Drugs Do/Did You Use?

 

 

 

 

 

 

 

When Did You Last Use?

 

 

 

 

 

 

 

How Much/Often? (Circle) Daily Weekly

 

Monthly

Cost?

 

 

Have You Ever Entered Or Completed An Alcohol Or Drug Treatment Program?

(Circle) Yes No

If Yes, Give Details:

Have You Ever Had Contact With A Child Protective Service Agency?

(Circle) Yes No

If Yes, Give Details And County:

 

 

 

GR001

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PROPOSED GUARDIAN #1 continued

Have You Ever Been Arrested For Domestic Violence? If Yes, Give Details:

Name And Address of Employer:

 

 

 

 

 

 

 

 

Phone (

)

 

 

 

 

 

 

 

 

Title:

 

 

 

 

 

 

 

 

How Long?

 

 

 

 

 

 

 

 

 

Days You Work:

 

 

 

Hours:

 

 

 

 

 

 

 

 

 

 

Gross Salary:

 

 

 

Other Income (Circle)

 

 

 

 

 

 

 

 

AFDC

 

SOC. SEC. UNEMPLOYMENT CHILD SUPPORT

MEDI-CAL ONLY

Amount $

 

 

 

 

Mo/Wk

 

 

For Whom Received:

 

 

 

Have You Ever Filed Bankruptcy: (Circle)

Yes No

 

 

If So Date:

 

 

 

 

 

Place:

 

 

 

 

Result:

 

 

 

Have You, Your Spouse Or Either Parent Ever Been Involved In Any Of The Following?

Received Counseling For Domestic Violence? (Circle)

Yes

No

Domestic Dispute Where Law Enforcement Was Called: (Circle)

Yes

No

Been The Subject Of A Domestic Or Civil Restraining Order? (Circle)

Yes

No

If Yes For Any, Give Date/Place/Case No./Court/Law Enforcement Agency/And Details For Each Incident:

PROPOSED GUARDIAN #2

 

 

 

 

FULL NAME:

 

OTHER NAMES/MAIDEN

 

 

 

 

 

 

 

Date of Birth/Birth Place

 

 

CA ID/DL NO.

 

GR001

Page 3 of 12

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PROPOSED GUARDIAN #2 continued

Social Security No.

List Addresses for Past Five Years

1.

 

 

 

 

 

 

 

Phone No. (

)

 

 

 

 

 

From

to

 

( ) Own ( ) Rent

 

Rent/Mortgage $

 

/Month

 

2.

 

 

 

 

 

 

 

Phone No. (

)

 

 

 

 

 

From

to

 

( ) Own ( ) Rent

 

Rent/Mortgage $

 

/Month

 

3.

 

 

 

 

 

 

 

Phone No. (

)

 

 

 

 

 

From

to

 

( ) Own ( ) Rent

 

Rent/Mortgage $

 

/Month

 

Your Health (Circle)

Good

 

Fair

Poor

State Any Medical Conditions Currently Being Treated For:

Medications – Name, Amount, Reason, How Often Taken:

Attending Counseling? (Circle)

Yes No

Type:

 

Name of Counselor:

Have You Ever Been Convicted Of An Offense Other Than A Minor Traffic Violation?

(Circle) Yes No

If Yes, Please List Date:

 

City:

Outcome:

 

 

 

 

 

Have You Ever Been On Or Are You On Probation/Parole? (Circle) Yes

No

GR001

Page 4 of 12

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PROPOSED GUARDIAN #2 continued

 

 

 

 

 

 

Officer/Agent’s Name:

 

 

County/Phone No.

 

Do You Drink Alcoholic Beverages? (Circle)

Yes No How Much/Often?

What Drugs Do/Did You Use?

 

 

 

 

 

 

 

When Did You Last Use?

 

 

 

 

 

 

 

How Much/Often? (Circle) Daily Weekly

 

Monthly

Cost?

 

Have You Ever Entered Or Completed An Alcohol Or Drug Treatment Program?

(Circle) Yes No

If Yes, Give Details:

Have You Ever Had Contact With A Child Protective Service Agency?

(Circle) Yes No

If Yes, Give Details And County:

Have You Ever Been Arrested For Domestic Violence? If Yes, Give Details:

Name And Address of Employer:

 

 

 

 

 

 

Phone (

)

 

 

 

 

 

 

 

 

Title:

 

 

 

 

 

 

How Long?

 

 

 

 

 

 

 

 

 

Days You Work:

 

Hours:

 

 

 

 

 

 

 

 

 

 

Gross Salary:

 

Other Income (Circle)

 

 

 

 

 

 

AFDC

 

SOC. SEC. UNEMPLOYMENT CHILD SUPPORT MEDI-CAL ONLY

Amount $

 

 

 

 

Mo/Wk

 

 

For Whom Received:

 

Have You Ever Filed Bankruptcy: (Circle)

Yes No

If So Date:

 

 

 

 

 

Place:

 

 

 

 

Result:

 

GR001

Page 5 of 12

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PROPOSED GUARDIAN #2 continued

Have You, Your Spouse Or Either Parent Ever Been Involved In Any Of The Following?

Received Counseling For Domestic Violence? (Circle)

Yes

No

Domestic Dispute Where Law Enforcement Was Called: (Circle)

Yes

No

Been The Subject Of A Domestic Or Civil Restraining Order? (Circle)

Yes

No

If Yes For Any, Give Date/Place/Case No./Court/Law Enforcement Agency/And Details For Each Incident:

OTHER ADULTS RESIDING IN THE HOME OF PROPOSED GUARDIAN(S)

Full Name:

 

 

Other Names/Maiden:

 

Relationship:

 

Date of Birth:

 

Occupation:

 

Does This Person Have Any Criminal Record: (Circle) Yes

No

If Yes, Where/When?

 

 

Charges:

 

 

 

 

Full Name:

 

 

Other Names/Maiden:

 

Relationship:

 

Date of Birth:

 

Occupation:

 

Does This Person Have Any Criminal Record: (Circle) Yes

No

If Yes, Where/When?

 

 

Charges:

 

 

 

 

Full Name:

 

 

Other Names/Maiden:

 

Relationship:

 

Date of Birth:

 

Occupation:

 

Does This Person Have Any Criminal Record: (Circle) Yes

No

If Yes, Where/When?

 

 

Charges:

 

 

 

 

GR001

Page 6 of 12

Rev 02/04

 

 

OTHER CHILDREN RESIDING IN THE HOME OF PROPOSED GUARDIAN(S)

Full Name:

 

Date Of Birth:

Name And Address of School:

Relationship:

Full Name:

 

Date Of Birth:

Name And Address of School:

Relationship:

Full Name:

 

Date Of Birth:

Name And Address of School:

Relationship:

BIRTH PARENTS

Natural Mother

 

 

 

 

 

 

Full Name:

 

 

 

Other Names/Maiden

 

Date of Birth:

 

CA ID/DL No.

 

Social Security No.

 

 

 

 

 

 

 

 

 

Last Known Address/Dates Lived There

Name And Address Of Employer

Telephone No.

 

 

 

 

 

Is Mother In Agreement With Guardianship? (Circle)

Yes

No

Does Mother Contribute To Support Of Child? (Circle)

Yes

No

If Yes, How?

 

 

 

 

Does Mother Visit With The Child? (Circle)

Yes

 

No

If Yes, How Often?

 

 

 

 

GR001

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BIRTH PARENTS – Natural Mother Continued

 

 

 

 

Does The Mother Visit The Child Outside Of Your Home? (Circle)

Yes

No

Does The Mother Send Cards, Gifts Or Call For Holidays? (Circle)

Yes

No

Does The Mother Express An Interest In School Issues? (Circle)

Yes

No

Does Mother Express An Interest In Health Issues? (Circle)

Yes

No

Does The Mother Have Any Other Children? (Circle)

Yes

No

If Yes Name:

 

Date Of Birth:

 

 

 

If Yes Name:

 

Date Of Birth:

 

 

 

If Yes Name:

 

Date Of Birth:

 

 

 

Has The Mother Ever Been Arrested And/Or Convicted? (Circle)

Yes

No

If Yes, Give Date/Place/Charges:

 

 

 

 

 

Has The Mother Ever Been Investigated By Child Protective Services? (Circle)Yes No

If Yes, Give Date/Place/Charges:

Is There A Custody Order (From Divorce, Separation, Paternity) For This Child In Any

County? (Circle) Yes No.

If Yes, Give County/Case No. And Any Details:

Natural Father

 

 

 

 

 

 

Full Name:

 

 

 

Other Names

 

Date of Birth:

 

CA ID/DL No.

 

Social Security No.

 

 

 

 

 

 

 

 

 

GR001

Page 8 of 12

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BIRTH PARENTS – Natural Father Continued

Last Known Address/Dates Lived There

Name And Address Of Employer

Telephone No.

 

 

 

 

 

 

Is Father In Agreement With Guardianship? (Circle)

Yes

No

 

Does Father Contribute To Support Of Child? (Circle)

Yes

No

 

If Yes, How?

 

 

 

 

 

Does Father Visit With The Child? (Circle)

Yes

No

 

 

If Yes, How Often?

 

 

 

 

 

Does The Father Visit The Child Outside Of Your Home? (Circle)

Yes

No

Does The Father Send Cards, Gifts Or Call For Holidays? (Circle)

Yes

No

Does The Father Express An Interest In School Issues? (Circle)

Yes

No

Does Father Express An Interest In Health Issues? (Circle)

Yes

No

Does The Father Have Any Other Children? (Circle)

Yes

No

If Yes Name:

 

Date Of Birth:

 

 

If Yes Name:

 

Date Of Birth:

 

 

If Yes Name:

 

Date Of Birth:

 

 

Has The Father Ever Been Arrested And/Or Convicted? (Circle)

Yes

No

If Yes, Give Date/Place/Charges:

 

 

 

 

 

 

 

 

 

GR001

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BIRTH PARENTS - Natural Father Continued

Has The Father Ever Been Investigated By Child Protective Services? (Circle)Yes No

If Yes, Give Date/Place/Charges:

Is There A Custody Order (From Divorce, Separation, Paternity) For This Child In Any

County? (Circle) Yes No.

If Yes, Give County/Case No. And Any Details:

 

 

 

 

 

 

GENERAL INFORMATION

 

Were The Birth Parents Ever Married? (Circle)

Yes

No

If Yes, Status:

 

 

 

 

 

 

 

If No, Was Paternity Ever Established (Circle)

Yes

No

If Yes, Case No.

 

Name/County Of Court House:

 

 

Is There An Order For Support? (Circle)

Yes

No

If Yes, How Much:

 

 

 

Paid To Whom?

 

 

Does The Child(ren) Have Native American Blood? (Circle) Yes

No

Name of Tribe:

 

 

 

 

 

 

 

Indian Percentage:

 

 

 

 

 

 

 

Is Child(ren) A Registered Tribal Member? (Circle)

 

Yes

No

GR001

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Rev 02/04

 

 

 

 

 

 

CHILDREN

Child(ren) Under Guardianship

 

 

 

 

 

 

First Child/Name:

 

 

 

 

Date/Place Of Birth:

 

Relationship:

 

 

Date Placed With Guardian:

 

Previous Schools:

 

 

 

 

 

 

 

Name

 

Address

 

Name/Address Of Child’s Physician:

Results of Drug Test At Birth:

Do You Suspect Mother Used Drugs When Pregnant?

Does The Child Have Any Behavioral Problems And/Or Needs: (Circle)

Yes No

If Yes, Explain:

 

 

 

 

Difficulties In School? (Circle)

Yes

No

 

Special Needs? (Circle)

Yes

No

 

Criminal Involvement? (Circle)

Yes

No

 

Second Child/Name:

 

 

 

 

Date/Place Of Birth:

 

Relationship:

 

 

 

Date Placed With Guardian:

 

Previous Schools:

 

 

 

 

 

 

 

 

Name

 

 

Address

 

Name/Address Of Child’s Physician:

Results of Drug Test At Birth:

Do You Suspect Mother Used Drugs When Pregnant?

Does The Child Have Any Behavioral Problems And/Or Needs: (Circle)

Yes No

If Yes, Explain:

GR001

Page 11 of 12

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CHILDREN CONTINUED

 

 

Difficulties In School? (Circle)

Yes

No

Special Needs? (Circle)

Yes

No

Criminal Involvement? (Circle)

Yes

No

REMINDE R YOU MU S T ATT ACH A COPY OF E ACH CHI L D’S B IRTH CERTI FICAT E AND/OR ANY DEATH CERTIFICATE FOR A NATURAL PARENT TO THIS FORM

Additional Information

List Any Other Information You Feel May Be Helpful To The Investigation

I DECLARE UNDER PENALTY OF PERJURY THAT THE INFORMATION ON THIS FORM IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE

DATED:

PRINTED NAME OF PETITIONER:

SIGNATURE

 

SIGNATURE

GR001

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