On (date of application): , applicant applied by affidavit to a social worker to commence proceedings
based on the allegations described above. (Attach a copy of the Application to Commence Proceedings, form JV-210.)
Applicant on information and belief alleges that the child below is at risk of abuse or neglect and should come within the jurisdiction
of the court (supply all information known):
4. The child described in item 3 above
a.
Form Approved for Optional Use
Judicial Council of California
JV-212 [Rev. September 1, 2018]
APPLICATION TO REVIEW DECISION BY SOCIAL WORKER
NOT TO COMMENCE PROCEEDINGS
(Welf. & Inst. Code, § 331)
Welfare and Institutions Code, § 331
Applicant's name and address:
resides within this county.
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
CHILD'S NAME:
APPLICATION TO REVIEW DECISION BY SOCIAL WORKER
NOT TO COMMENCE PROCEEDINGS
(Welf. & Inst. Code, § 331)
FOR COURT USE ONLY
CASE NUMBER:
JV-212
ATTORNEY OR PARTY WITHOUT ATTORNEY
STATE BAR NUMBER:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
1.
Applicant's relationship to child (specify):
2.
3.
Child's name:
b.
Age:
c.
Date of birth:
d.
Sex:
e.
Mother's name:
f.
Mother's address:
g.
Father's name:
h.
Father's address:
i.
Other (state name, address, and relationship to child):
a.
was in this county at the time of the facts alleged below.
b.
5.
Facts in support (State supporting facts concisely; include all known and relevant dates, times, names, and addresses. Attach
separate pages as necessary.):
See attachment 5.
6.
7.
It has been three weeks since the application to commence proceedings, and no petition to commence proceedings has been filed
by the social worker on behalf of this child.
8.
Applicant now requests the juvenile court review the decision of the social worker, and issue an order compelling the social worker
to commence juvenile court proceedings.
(SIGNATURE OF APPLICANT)
Date:
(TYPE OR PRINT NAME)
THE COURT FINDS AND ORDERS
9.
The court has reviewed the application and orders that
the social worker is hereby ordered to commence proceedings by filing a petition pursuant to Welfare and Institutions
Code section 300 based on the allegations set forth in the application.
b.
the decision of the social worker not to commence proceedings is affirmed.
a.
Date:
JUDICIAL OFFICER
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