Child Guardianship Questionnaire

Child Guardianship Questionnaire

Please complete this questionnaire to provide all necessary information for a Nevada child guardianship case. Answer each section as thoroughly as possible.
NRS240A DISCLOSURE - Read Carefully.

I, DEBORAH BARNHART, DOING BUSINESS AS DPS OF NORTHERN NEVADA, AM NOT AN ATTORNEY IN THE STATE OF NEVADA. I AM NOT AUTHORIZED TO GIVE LEGAL ADVICE OR LEGAL REPRESENTATION. I MAY NOT ACCEPT FEES FOR GIVING LEGAL ADVICE OR LEGAL REPRESENTATION.
Court / Judicial District and County

Enter the Nevada county where this guardianship case will be filed.
County*
Petitioner Information

Provide complete information about the primary petitioner.
Full Legal Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Government-Issued ID Number and State (e.g., Driver's License)
Ethnicity
Employer Name
Employer Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer Phone Number
Please enter a valid phone number.
Co-Petitioner Information

If there is a co-petitioner, provide their information below. If not, you may skip this section.
Full Legal Name (Co-Petitioner)

First NameMiddle NameLast Name
Date of Birth (Co-Petitioner)

MonthDayYear
Date
Phone Number (Co-Petitioner)
Please enter a valid phone number.
Email Address (Co-Petitioner)
example@example.com
Home Address (Co-Petitioner)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address (Co-Petitioner, if different)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Government-Issued ID Number and State (e.g., Driver's License) (Co-Petitioner)
Ethnicity (Co-Petitioner)
Employer Name (Co-Petitioner)
Employer Address (Co-Petitioner)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer Phone Number (Co-Petitioner)
Please enter a valid phone number.
Protected Child(ren) Information

Provide details for each child for whom guardianship is sought.
Protected Child Information*
Are there any existing court cases regarding custody or visitation for this child?*

YesNo
If yes, please explain (case type, location, parties involved):
Are there any domestic violence, TPO, termination of parental rights, or adoption proceedings affecting this case?*

YesNo
If yes, please explain:
Is there anyone else with physical custody of or claiming legal rights to the child(ren)?*

YesNo
If yes, please explain:
Reason for seeking guardianship*
Benefits and Insurance

Please answer the following regarding the child's benefits and insurance.
Is the child receiving welfare or Medicaid benefits?*

YesNo
Is the child covered by insurance through your employer?*

Yes (Self)Yes (Other)No
If yes (Other), who provides the insurance?
Is the child covered by any other insurance?*

YesNo
If yes, who provides the other insurance?
Future Needs

Information about the child's future care and guardianship needs.
Is permanent guardianship needed after the child turns 18?*

YesNo
Are there any viable alternatives for the child's care?*

YesNo
If yes, please explain:
Guardian Authority Requests

Please specify which authorities you are requesting as guardian.
Do you request authority to make medical decisions for the child?*

YesNo
Do you request authority to make legal decisions for the child?*

YesNo
Do you request authority to make financial decisions for the child?*

YesNo
Rights Retention

Specify which rights the child should retain if guardianship is granted.
Should the child retain the right to vote?*

YesNo
Should the child retain the right to possess firearms?*

YesNo
Should the child retain the right to a driver's license?*

YesNo
Litigation and Legal Proceedings

Information about litigation or legal proceedings relevant to the child.
Is the child a party to any pending lawsuit?*

YesNo
Is guardianship being sought in order to initiate a lawsuit?*

YesNo
Is the child currently under investigation for abuse, neglect, or exploitation?*

YesNo
Has the child executed a nomination of guardian?*

YesNo
If yes, who was nominated?
Does the child have any assets?*

YesNo
If yes, please describe the assets:
Child’s Relatives

List the child’s relatives. You may add multiple relatives as needed.
Child's Relatives
NRS240A DISCLOSURE - Read Carefully.

Please review and confirm the information below.
I, DEBORAH BARNHART, DOING BUSINESS AS DPS OF NORTHERN NEVADA, AM NOT AN ATTORNEY IN THE STATE OF NEVADA. I AM NOT AUTHORIZED TO GIVE LEGAL ADVICE OR LEGAL REPRESENTATION. I MAY NOT ACCEPT FEES FOR GIVING LEGAL ADVICE OR LEGAL REPRESENTATION.*

I understand that Deborah Barnhart, dba DPS of NorthernNevada, is not an attorney and is acting solely as a legal document preparer.
Name*

First NameMiddle NameLast Name
Should be Empty:

Child Guardianship Questionnaire

NRS240A DISCLOSURE - Read Carefully.

Court / Judicial District and County

Petitioner Information

Co-Petitioner Information

Protected Child(ren) Information

Benefits and Insurance

Future Needs

Guardian Authority Requests

Rights Retention

Litigation and Legal Proceedings

Child’s Relatives

NRS240A DISCLOSURE - Read Carefully.