Petitioner on information and belief alleges the following:
The child named below comes within the jurisdiction of the juvenile court under the following subdivisions of section 300 of the
Welfare and Institutions Code (check applicable boxes; see attachment 1a for concise statements of facts):
a.
(a) (b)(1) (b)(2) (c) (d) (e) (f) (g) (h) (i) (j)
Child's name:
b.
Gender:
e.
JUVENILE DEPENDENCY PETITION (VERSION ONE)
Welfare and Institutions Code, § 300 et seq.;
Cal. Rules of Court, rule 5.504
www.courts.ca.gov
Form Adopted for Alternative Mandatory Use
Instead of Form JV-110
Judicial Council of California
JV-100 [Rev. January 1, 2020]
Page 1 of 2
2.
Indian Child Welfare Act Inquiry (check one):
(See important notice on page 2.)
CHILD'S NAME:
FOR COURT USE ONLY
CASE NUMBER:
JUVENILE DEPENDENCY PETITION (VERSION ONE)
(Welf. & Inst. Code, § 300 et seq.)
JV-100
RELATED CASE (if any):
ATTORNEY OR PARTY WITHOUT ATTORNEY
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
STATE BAR NO.:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
For counties filing a separate dependency petition for each child or for counties using Additional Children Attachment (form JV-101(A))
§ 300—Original
§ 342—Subsequent
§ 387—Supplemental
1.
Age:c. Date of birth:d.
Name:
Address:
If mother or father (check all that apply):
f.
mother
father
guardian
unknown
legal
biological
presumed
alleged
Name:
Address:
If mother or father (check all that apply):
g.
mother
father
guardian
unknown
legal
biological
presumed
alleged
Name:
Address:
If mother or father (check all that apply):
h.
mother
father
guardian
unknown
legal
biological
presumed
alleged
Prior to intervention, child resided with
parent (name):
guardian (name):
other (state name, address, and relationship to child):
Indian custodian (name):
j.
parent (name):
Other (state name, address, and relationship to child):
i.
No known parent or guardian resides within this state. This adult
relative lives in this county or is closest to this court.
Child is
Date and time of detention:
Current place of detention (address):
k.
not detained
detained
Relative
Shelter/foster care
Other
a.
I have asked as to whether the child is or may be a member of an Indian tribe or eligible for membership and the
biological child of a member and the Indian Child Inquiry Attachment (form ICWA-010(A)) is attached.
b.
On information and belief, I am aware that inquiry has been completed by (insert name)
and the Indian Child Inquiry Attachment (form ICWA-010(A)) is attached.
JV-100 [Rev. January 1, 2020]
Page 2 of 2
JUVENILE DEPENDENCY PETITION (VERSION ONE)
JV-100
CASE NUMBER:
CHILD'S NAME:
Other children are listed on Additional Children Attachment (form JV-101(A))
— NOTICE —
TO PARENT
Your parental rights may be permanently terminated. To protect your rights, you must appear
in court and answer this petition.
You and the estate of your child may be jointly and severally liable for the cost of the care,
support, and maintenance of your child in any placement or detention facility, the cost of legal
services for you or your child by a public defender or other attorney, and the cost of supervision
of your child by order of the juvenile court.
TO PARENTS OR OTHERS LEGALLY RESPONSIBLE
FOR THE SUPPORT OF THE CHILD
(SIGNATURE OF PETITIONER)
Date:
Address and telephone number (if different person signing than listed in caption above):
Petitioner requests that the court find these allegations to be true.
I declare under penalty of perjury under the laws of the State of California that the foregoing and all attachments are true and correct.
3.
(TYPE OR PRINT NAME)
Number of pages attached:
2.
c.
Inquiry about whether the child is or may be a member of an Indian tribe or eligible for membership and the biological
child of a member has not yet been completed for the reasons set out below. I am aware of the ongoing duty to
complete this inquiry and will complete the Indian Child Inquiry Attachment (form ICWA-010(A)) and submit it to the court
as soon as possible.
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