Fill and Sign the Childs Namecase Number Form

JV-101 CHILD'S NAME: CASE NUMBER: ––––– ––––– 3. Petitioner on information and belief further alleges the following: 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): (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) b. Child's name: ––––– 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.) f. Name: ––––– mother g. Name: ––––– mother Address: ––––– father Address: ––––– father ––––– guardian ––––– guardian ––––– unknown ––––– unknown If mother or father (check all that apply): If mother or father (check all that apply): legal biological presumed alleged legal biological presumed alleged h. Name: ––––– mother i. Other (state name, address, and relationship to child): Address: ––––– father ––––– ––––– guardian ––––– ––––– unknown ––––– If mother or father (check all that apply): No known parent or guardian resides within this state. This adult legal biological presumed alleged relative lives in this county or is closest to this court. j. Prior to intervention, child resided with k. Child is parent (name): ––––– not detained detained parent (name): ––––– Date and time of detention: ––––– guardian (name): ––––– Current place of detention (address): ––––– other (state name, address, and relationship to child): ––––– ––––– ––––– ––––– Relative Shelter/foster care Other l . Child may be a member of, or may be eligible for membership in, a federally recognized Indian tribe. m. Child may be of Indian ancestry. 4. 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): (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) b. Child's name: ––––– 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.) f. Name: ––––– mother g. Name: ––––– mother Address: ––––– father Address: ––––– father ––––– guardian ––––– guardian ––––– unknown ––––– unknown If mother or father (check all that apply): If mother or father (check all that apply): legal biological presumed alleged legal biological presumed alleged h. Name: ––––– mother i. Other (state name, address, and relationship to child): Address: ––––– father ––––– ––––– guardian ––––– ––––– unknown ––––– If mother or father (check all that apply): No known parent or guardian resides within this state. This adult legal biological presumed alleged relative lives in this county or is closest to this court. j. Prior to intervention, child resided with k. Child is parent (name): ––––– not detained detained parent (name): ––––– Date and time of detention: ––––– guardian (name): ––––– Current place of detention (address): ––––– other (state name, address, and relationship to child): ––––– ––––– ––––– ––––– Relative Shelter/foster care Other l . Child may be a member of, or may be eligible for membership in, a federally recognized Indian tribe. m. Child may be of Indian ancestry. Page of Form Adopted for Mandatory Use Cal. Rules of Court, rule 5.504 Judicial Council of California Welfare and Institutions Code, § 300 JV-101 [Rev. January 1, 2007] ADDITIONAL CHILDREN ATTACHMENT Juvenile Dependency Petition electronic form ã 2005-7 WWW.LawCA.co m Law Publishers