ATTACHMENT JV-2002a
JV-2002a REV. 07/01/13
DECLARATION FOR JUVENILE COURT RECORD
(DEPENDENCY)
Page 1 of 1
ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.:
I am:
1.
Child or Former Dependent
2.
Mother of the named juvenile (name, “AKA” and DOB)
3.
Father of the named juvenile (name, “AKA” and DOB)
4.
Guardian of the named juvenile (name, “AKA” and DOB)
5.
Court-Appointed Special Advocate (CASA)
6.
District Attorney - State Bar Number:
7.
Attorney - State Bar Number: Representing:
8.
Sixth Appellate District Program Member
9.
Other: (specify)
10. Address:
11.
I am requesting to view the following record(s) relating to the minor:
12. Which are held by:
a.
Court Clerk, Juvenile Dependency Division
b.
Department of Family & Children Services
13.
I request copies of the following record(s) [copies of records may be subject to a fee pursuant to statute]:
Use of juvenile records is subject to Petition under Welfare & Institutions Code § 827 [JV-570] and further Court
authorization. I understand these records are confidential.
I declare under penalty of perjury the forgoing is true and correct.
Dated this
day of , 20 , at San José, California
Signature:
Type or print name:
ATTORNEY FOR (Name):
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA
Street Address: 115 Terraine Street, San José, CA 95113
Mailing Address: 191 North First Street, San José, CA 95113
Branch Name: Juvenile Dependency
In the Matter of:
(Name of Child),
a Minor. [D.O.B.
_________ ]
CASE NUMBER:
DECLARATION FOR JUVENILE COURT RECORD (DEPENDENCY)
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