CONFIDENTIAL
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO
REFERRAL FOR CII/CARPOS/ICMS REPORT
(GUARDIANSHIP/CONSERVATORSHIP)
Form A1
This form is required with all Guardianship/Conservatorship filings
SB-13548
(Rev. 01/18/13) Mandatory
Case Number
Ex Parte Hearing Date
Department
This Section to be Completed by Filing Party
Petitioner Name: Male
Female
Petitioner Former Name:
Petitioner AKAs, if any:
Petitioner Date of Birth: Petitioner SSN:
Second Petitioner Name: Male
Female
Second Petitioner Former Name:
Second Petitioner AKAs, if any:
Second Petitioner Date of Birth: Second Petitioner SSN:
Other Member of Household 18 Years Old & Older:
MALE FEMALE
NAME:
Date of Birth: SSN:
Other Member of Household 18 Years Old & Older:
MALE FEMALE
NAME:
Date of Birth: SSN:
Other Member of Household 18 Years Old & Older:
MALE FEMALE
NAME:
Date of Birth: SSN:
Name of Minors Natural Mother:
Date of Birth: SSN:
Name of Minors Natural Father:
Date of Birth: SSN:
COURT ORDER:
This matter is referred to Family Law Processing for a CARPOS (CLETS) history report and a
Criminal History Inquiry (CII) pursuant to Family Code 6306 and/or California Rule of Court 5.445.
This matter is referred to Family Law Processing for a search of the Superior Court of California,
County of San Bernardino Integrated Case Management System for a history report regarding
existing custody and visitation orders pursuant to CRC 5.445.