Fill and Sign the Fillable Online Jv569 1 Clerk Stamps Date Here When Form is Filed

JV-569 Proof of Service — Request for Disclosure Clerk stamps date here when form is filed. Fill in court name and street address: Superior Court of California, County of Case Number: Fill in case number if known: JV-569, Page 1 of 3 Judicial Council of California, New January 1, 2009, Mandatory Form Welfare and Institutions Code, § 827 California Rules of Court, rules 5.552, 5.553 I was not able to provide notice of this petition to the following because I did not know their names or addresses. If this is a request for the case file of a livin g child, the clerk must serve a copy of the petition. If this is a request for the case file of a deceased child, the custodian of records must serv e a copy of the petition. 2 a. Attorney of record for the child Child’s parent Probation department if petition filed under section 601 or 602 District attorney if petition filed under section 601 or 602 Child Child welfare agency/custodian of records if petition filed under section 300 Child’s identified Indian tribe Child’s CASA volunteer County counsel or other attorney representing th e child welfare agency if petition filed under section 300 Copies of Request for Disclosure of Juvenile Case File (JV-570), Notice of Request for Disclosure of Juvenile Case File (JV-571), and a blank Objection to Release of Juvenile Case File (JV-572) have been placed in a sealed envelope with postage paid and depos ited in the United States mail addressed to th e following: a. County counsel or ot her attorney representing the child welfar e agency if petition filed under 3 section 300 (name and address): Proof of Service —Request for Disclosure Child’s legal guardian Your name: Relationship to child (if any): Street address: State: City: Zip: Lawyer (if any) (name, address, tele phone numbers, and State Bar number): 1 Telephone number: b . c. d. e. f. g. h. i. j. Date mailed: or Personally served on (date): Your name: Case Number:JV-569, Page 2 of 3 New January 1, 2009, Mandatory Form h. Probation department if petition filed under section 601 or 602 (name and address): e. Child’s parent (name and address): g. Child’s legal guardian (name and address): f. Child’s parent (name and address): Proof of Service —Request for Disclosure b. District attorney if petition filed under section 601 or 602 (name and address): c. Child (name and address): d. Attorney of record for the child (name and address): Date mailed: or Personally served on (date): Date mailed: or Personally served on (date): Date mailed: or Personally served on (date): Date mailed: or Personally served on (date): Date mailed: or Personally served on (date): Date mailed: or Personally served on (date): Date mailed: or Personally served on (date): Your name: Case Number:JV-569, Page 3 of 3 New January 1, 2009, Mandatory Form j. The Indian child’s tribal representative (name and address): k. The child’s CASA volunteer (name and address): I declare under penalty of perjury under the laws of the State of California that the information in this form is true and correct. This means that if I lie on this form, I am guilty of a crime. 4 Date: Sign your name Type or print your name Proof of Service—Request for Disclosure i. Child welfare agency/custodi an of records if petition filed under section 300 (name and address): Date mailed:or Personally served on (date): Date mailed: or Personally served on (date): Date mailed: or Personally served on (date):