DILIGENT SEARCH REQUEST FORM - Florida's Center for Child ...



DILIGENT SEARCH REQUEST FORM

( Original request ( Updated Request

|Requestor: | |Case Name: | |

|Date: | |FSFN Case #: | |

This request should be initiated and completed by the Child Protective Investigator for the search of missing parents and known relatives per Chapter 39.503, Florida Statutes (F.S.), Administrative Code 65C-30.003 and CFOP 175-22. Upon investigation commencement, CPI shall initiate the search as soon as it is learned that the identity or location is unknown for a parent or prospective parent.

|Section I – A. Child and Parents’ Demographics (include full name if known (first, middle and last)) |

|Child’s Name: | |DOB: | |SSN: | |

| |Race: | |Gender: | |

| |

|Mother’s Name: | |DOB: |SSN: |

|Mother’s Maiden Name: | |Race: | |

|Primary Language: | |Place of Birth: |

| |

|Prospective Father’s Name: | |DOB: |SSN: |

|Father of: | |Race: | |

|Primary Language: | |Place of Birth: |

|Section I – B. Additional Information |

|Source |Address/Phone |Information Obtained |

| | | |

| | | |

| | | |

| | | |

|Section II – Missing Parent Information |

|Name of Missing Parent: | |Relationship to Child(ren): |

|Aliases: | |DOB: |SSN: |

|Birthplace: | |Race: |Gender: |

|(State/Country) | | | |

|Height: |Weight: |Hair Color: |Eye Color: |Birthmark(s): |

|Last Known Address: | |

|Possible | |

|Home/Cell Phone: | |

|Past Addresses: | |

|Current or Past Employers: | |

|Line of Work: | |

| Criminal Arrests or | |

|Probation - List | |

|county/state: | |

|Obtain the following information at the shelter hearing or when a dependency petition is filed: |

|F.S. 39.503(1) dictates that the Court conduct inquiry of parent/legal custodian or of any relative/current custodian present at hearing if the identity or |

|location of a parent is unknown OR this information can be provided to the Court via a sworn affidavit by a person having personal knowledge. If this |

|information was obtained through a sworn affidavit you do not need to duplicate this information again. Attach the affidavit to this form. |

|Parent was present at court and information obtained or |

|Parent not in court and CPI to provide information |

|Currently Married? Y or N |

|Was the mother married at the time of the probable conception and/or at the time of birth? Y or N |

|Was the mother living with a male at the time of the probable conception and/or at the time of birth? Y or N |

|Has the mother named any man as the father on the birth certificate or in connection with applying for or receiving public assistance? Y or N |

|If yes, identify the man’s name: ________________________________ |

|Has the mother received payments or promises of support with respect to the child or because of her pregnancy from a man who claims to be the father? Y or N |

|If yes, identify the man’s name: ________________________________ |

|Has any man acknowledged or claimed paternity of the child in a jurisdiction in which the mother resided at the time of probable conception and/or since the |

|inception, or in which the child has resided or resides? |

|Y or N |

|If yes, identify the man’s name: ________________________________ |

|Section III – Child/Parents’ Relatives Information |

|Maternal Relatives |

|Relationship to Child(ren) |Name |Address/Phone Number |Information received as to Missing Parent’s |

| | | |Whereabouts |

|Grandmother | | | |

|Grandfather | | | |

|Aunt | | | |

|Uncle | | | |

|Cousin | | | |

|Great-Aunt | | | |

|Half-Sibling | | | |

| |

|Paternal Relatives |

|Relationship to Child(ren) |Name |Address/Phone Number |Information received as to Missing Parent’s |

| | | |Whereabouts |

|Grandmother | | | |

|Grandfather | | | |

|Aunt | | | |

|Uncle | | | |

|Cousin | | | |

|Great-Aunt | | | |

|Half-Sibling | | | |

| | | | |

I, ______________, declare that the below efforts were made in a good faith attempt to locate ____________, parent of _______________, and that his whereabouts remain unknown.

| | | |

|Signature | |Date |

|Section IV – Database Search Sources |

|Activity Type |Person /Agency |Subject of the |Date (date the |Outcome (actual results) |Conducted by |Comments |

| |Contacted |Search |search started) | | | |

|Child Caretaker | | | | | | |

|(Last known address, possible | | | | | | |

|relatives) | | | | | | |

|Child Legal Custodian | | | | | | |

|(Last known address, possible | | | | | | |

|relatives) | | | | | | |

|Computer Search – ACCURINT – (Last | | | | | | |

|known address, possible relatives, | | | | | | |

|or property owned; Zabasearch / | | | | | | |

|White Pages) | | | | | | |

|Court Records | | | | | | |

|(Civil Actions, Divorce | | | | | | |

|Settlements, or restraining | | | | | | |

|orders/Injunction) | | | | | | |

|Criminal/Prison Records – Computer | | | | | | |

|Prison Search (Open or closed | | | | | | |

|supervision address) | | | | | | |

|Criminal/Prison Records – | | | | | | |

|County/Local Jail (Last address | | | | | | |

|reported) | | | | | | |

|Criminal/Prison Records – FCIC | | | | | | |

|(Last address reported) | | | | | | |

|Criminal/Prison Records – Local | | | | | | |

|Police Dept (Last address reported)| | | | | | |

|Criminal/Prison Records – NCIC | | | | | | |

|(Last address reported) | | | | | | |

|Criminal/Prison Records – Warrants | | | | | | |

|(Last address reported) | | | | | | |

|Friend | | | | | | |

|(Last known address, possible | | | | | | |

|relatives) | | | | | | |

|Local Government – Marriage Records| | | | | | |

|Local Government – Property Records| | | | | | |

|(Property owned) | | | | | | |

|Local Government – School Records | | | | | | |

|Parent Present – Information | | | | | | |

|received from another parents (i.e.| | | | | | |

|2 fathers) | | | | | | |

|Relative | | | | | | |

|(Last known address, possible | | | | | | |

|relatives) | | | | | | |

|State Agency (Non-Florida) – | | | | | | |

|Children/Family Services | | | | | | |

|(Identified previous residence in | | | | | | |

|other states) | | | | | | |

|State Agency (Non-Florida) – | | | | | | |

|Correction (Open or closed | | | | | | |

|supervision address) | | | | | | |

|State Agency (Non-Florida) – Prison| | | | | | |

|(Open or closed supervision | | | | | | |

|address) | | | | | | |

|State Agency (Non-Florida) – | | | | | | |

|Probation (Open or closed | | | | | | |

|supervision address) | | | | | | |

|State Agency – Dept of Children and| | | | | | |

|Families ACCESS – (Last known | | | | | | |

|address, payment received, date | | | | | | |

|contact made with subject, or names| | | | | | |

|of household occupants) | | | | | | |

|FSFN | | | | | | |

|(Possible contact information | | | | | | |

|including relatives) | | | | | | |

|State Agency – Dept of Corrections | | | | | | |

|(Open or closed supervision | | | | | | |

|address) | | | | | | |

|State Agency – Dept of Juvenile | | | | | | |

|Justice (Open or closed supervision| | | | | | |

|address) | | | | | | |

|State Agency – Dept of Revenue | | | | | | |

|(Child Support documented address | | | | | | |

|or last home / employment) | | | | | | |

|Vital Statistics – Birth | | | | | | |

|Certificate (Mother and Father’s | | | | | | |

|information) | | | | | | |

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