ADDITIONAL CHILDREN ATTACHMENT
Juvenile Dependency Petition
Page 1 of 1
Welfare and Institutions Code, § 300;
Cal. Rules of Court, rule 5.504
www.courts.ca.gov
Form Adopted for Mandatory Use
Judicial Council of California
JV-101(A) [Rev. July 1, 2016]
5.
a. 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 3a for concise statements of facts):
6. I have asked about Indian ancestry for each child and have completed and attached the required Indian Child Inquiry Attachment,
form ICWA-010(A).
JV-101(A)
CASE NUMBER:
CHILD'S NAME:
Petitioner on information and belief alleges the following:
4.
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 3a for concise statements of facts):
a.
(a)
(b)(1) (b)(2)
(c)
(d) (e)
(f)
(g)
(h)
(i)
(j)
Child's name:
b.
c.
Age:
d.
Date of birth:
e.
Sex:
Information is the same as that given for the child in item 1. (If not the same, provide different information below.)
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
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.
Prior to intervention, child resided with
parent (name):
guardian (name):
other (state name, address, and relationship to child):
Indian custodian (name):
j.
parent (name):
Child is
Date and time of detention:
Current place of detention (address):
k.
not detained
detained
Relative
Shelter/foster care
Other
(a)
(b)(1) (b)(2)
(c)
(d) (e)
(f)
(g)
(h)
(i)
(j)
Child's name:
b.
c.
Age:
d.
Date of birth:
e.
Sex:
Information is the same as that given for the child in item 1. (If not the same, provide different information below.)
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
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.
Prior to intervention, child resided with
parent (name):
guardian (name):
other (state name, address, and relationship to child):
Indian custodian (name):
j.
parent (name):
Child is
Date and time of detention:
Current place of detention (address):
k.
not detained
detained
Relative
Shelter/foster care
Other
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