Fill and Sign the California Code Section 497299202 Form

––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– –– ––– –– ––– ––––– ––––– –– ––– ––––– ––––– –– ––– –– ––– –– ––– ––––– ––––– ––––– JV- 210 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number if attorney, and mailing address): FOR COURT USE ONLY TELEPHONE NO. (Optional): FAX NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CHILD'S NAME: APPLICATION TO COMMENCE PROCEEDINGS BY AFFIDAVIT AND DECISION BY SOCIAL WORKER (Welf. & Inst. Code, § 329) CASE NUMBER: To the social worker or social services agency of (specify county): Count y: 1. Applicant's name and address: 2. Applicant's relationship to child (specify): 3. Applicant on information and belief alleges that the child is at risk of abuse or neglect and should come within the jurisdiction of the court (supply all information known): 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. Other (state name, address, and relationship to child): 4. The child described in item 3 above a . b . resides within this county. was in this county at the time of the facts alleged below. 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. Applicant requests that the social worker or agency immediately commence proceedings in the juvenile court on behalf of this child. Dat e: (TYPE OR PRINT NAME) (SIGNATURE OF APPLICANT) DECISION OF SOCIAL WORKER OR SOCIAL SERVICES AGENCY 7. After consideration of the application above, the SOCIAL WORKER HAS DECIDED a . b . to commence proceedings in juvenile court on these allegations. not to commence proceedings in juvenile court on these allegations because (specify): See attachment 7. Number of pages attached S. I declare I am asocial worker of the county in which this application was submitted, and duly authorized to make this decision. Dat e: (TYPE OR PRINT NAME) (SIGNATURE OF SOCIAL WORKER) ADDRESS AND TELEPHONE NUMBER: Form Approved for Optional Use Judicial Council of California JV-21 0 [New January 1, 2001 ] APPLICATION TO COMMENCE PROCEEDINGS BY AFFIDAVIT AND DECISION BY SOCIAL WORKER (Welf. & Inst. Code, § 329) Welfare and Institutions Code, § 329electronic form ã 2000 WWW.LawCA.com Law Publishers