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         JV-210ATTO RNEY O R P AR TY W IT H O UT A TTO RNEY ( N am e, s ta te b ar n um ber if a tto rn ey, a nd m ailin g a ddre ss ):F O R C O URT U SE O NLYT E LE PH O NE N O . ( O ptio nal) :F A X N O . ( O ptio nal) :E -M AIL A D DR ESS ( O ptio nal) :A TTO RNEY F O R ( N am e):S U PER IO R C O URT O F C ALIF O RNIA , C O UNTY O FSTREET ADDRESS:MAIL IN G A D D RESS:C IT Y A N D Z IP C O DE:BR AN CH N AM E:C HIL D 'S N AM E:A PPLIC ATIO N T O C O M MEN C E P R O CEED IN G S B Y A FFID AVIT AN D D EC IS IO N B Y S O CIA L W ORKER (W elf . & I n st. C ode, § 3 29)CASE N UM BER :T o t h e s o cia l w ork er o r s o cia l s erv ic es a g en cy o f ( s p ecif y c o unty ):C ounty :1 . A pplic a nt's n am e a nd a ddre ss:2 . A pplic a nt's r e la tio nsh ip t o c h ild ( s p ecif y ):3 . A pplic a nt o n in fo rm atio n a nd b elie f a lle ges t h at t h e c h ild is a t r is k o f a buse o r n egle ct a nd s h ould c o m e w it h in t h e ju ris d ic tio n o f t h eco urt ( s u pply a ll in fo rm atio n k n ow n):a. 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. O th er ( s ta te n am e, a ddre ss, a n d r e la tio nsh ip t o c h ild ): 4. T he c h ild d esc rib ed in it e m 3 a bo ve a .b.re sid es w it h in t h is c o unty . wa s in t h is c o unty a t t h e t im e o f t h e f a cts a lle ged b elo w .5. F acts in s u pport ( S ta te s u pportin g f a cts c o ncis e ly , in clu de a ll k n ow n a nd r e le va nt d ate s, t im es, n am es, a nd a ddre sse s. A tta ch se pa ra te p ages a s n ece ssa ry .) :S ee a tta ch m ent 5 .6. A pplic a nt r e quests t h at t h e s o cia l w ork e r o r a gency im media te ly c o m mence p ro ce edin gs in t h e ju ve nile c o urt o n b ehalf o f t h is c h ild .D ate :(T Y PE O R P R IN T N AM E)(S IG NATU RE O F A PPLIC AN T)D EC IS IO N O F S O CIA L W ORKER O R S O CIA L S ER VIC ES A G EN CY7. A fte r c o nsid era tio n o f t h e a pplic a tio n a bove , t h e S O CIA L W ORKER H AS D EC ID EDa.b.to c o m mence p ro ce edin gs in ju ve n ile c o urt o n t h ese a lle gatio ns. no t t o c o m mence p ro ce edin gs in ju ve nile c o urt o n t h ese a lle gatio ns b eca use ( s p ecif y ):S ee a tta ch m ent 7 . N um ber o f p age s a tta ch edS . I d ecla re I a m a so cia l w ork e r o f t h e c o unty in w hic h t h is a pplic a tio n w as s u bm it te d, a nd d uly a uth oriz e d t o m ake t h is d ecis io n.D ate :(T Y PE O R P R IN T N AM E)(S IG NATU RE O F S O CIA L W ORKER )AD DRESS A N D T E LE PH O NE N UM BER :Form A ppro ve d fo r O ptio na l U se Ju dic ia l C ouncil o f C alif o rn ia JV -2 1 0 [N ew J a nuary 1 , 2 001 ]A PPLIC ATIO N T O C O M MEN CE P R O CEED IN G S B Y A FFID AVIT AN D D EC IS IO N B Y S O CIA L W ORKER (W elf . & I n st. C ode, § 3 29)W elf a re a nd In stit u tio ns C od e, § 3 29electronic form 2000 WWW.LawCA.com Law Publishers