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.Format: (000) 000-0000.
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.Format: (000) 000-0000.
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.Format: (000) 000-0000.
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.Format: (000) 000-0000.
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?
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?
If yes, please explain:
Is there anyone else with physical custody of or claiming legal rights to the child(ren)?
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?
Is the child covered by insurance through your employer?
If yes (Other), who provides the insurance?
Is the child covered by any other insurance?
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?
Are there any viable alternatives for the child's care?
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?
Do you request authority to make legal decisions for the child?
Do you request authority to make financial decisions for the child?
Rights Retention

Specify which rights the child should retain if guardianship is granted.
Should the child retain the right to vote?
Should the child retain the right to possess firearms?
Should the child retain the right to a driver's license?
Litigation and Legal Proceedings

Information about litigation or legal proceedings relevant to the child.
Is the child a party to any pending lawsuit?
Is guardianship being sought in order to initiate a lawsuit?
Is the child currently under investigation for abuse, neglect, or exploitation?
Has the child executed a nomination of guardian?
If yes, who was nominated?
Does the child have any assets?
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.
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.