13-18124-360 [Rev. September 11, 2019]
REQUEST TO VACATE PACKET
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AGENCY SUBMITTING REQUEST (Name, Department, and address):
TELEPHONE NO: FAX NO (Optional):
E-MAIL ADDRESS (Optional):
For Court Use Only
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
-0955
BRANCH NAME:
JUVENILE DEPENDENCY COURT
CASE NAME:
REQUEST TO VACATE PACKET
JUVENILE DEPENDENCY PROCEEDING
Welfare & Institutions Code § 300
CASE NUMBER:
RELATED CASE (if any):
(Name of social worker) is requesting to vacate the packet dated (date of packet)
filed with the court on (date filed) for the following reason:
I served a copy of the REQUEST TO VACATE PACKET on (date) on the following persons or entities (indicate name of
person served and method of service):
☐
☐
☐
Children’s Advocacy Group:
☐
☐
☐
☐ Friedman & Cazares:
☐ Clark & Le, LLP:
☐ Friedland & Associates: ☐
At the time of service I was at least 18 years of age and not a party to this cause. I am a resident of or employed in the county where the
service occurred. My residence or business address is (specify):
I declare under the penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME)