Fill and Sign the Juvenile Dependency Form

For counties filing a separate dependency petition for each child or for counties using Additional Children Attachment (form JV-101) JV-100 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY ––––– ––––– ––––– TELEPHONE NO.: ––––– 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: ––––– CASE NUMBER: JUVENILE DEPENDENCY PETITION (VERSION ONE) ––––– (Welf. & Inst. Code, § 300 et seq.) RELATED CASES (if any): § 300—Original § 342—Subsequent § 387—Supplemental ––––– 1. Petitioner on information and belief 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 1a 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: ––––– ––––– ––––– ––––– 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 1 of 2 Form Adopted for Alternative Mandatory Use JUVENILE DEPENDENCY PETITION (VERSION ONE) Cal. Rules of Court, rule 5.50 Instead of Form JV-110 Welfare and Institutions Code, § 300 et seq. Judicial Council of California ( Welfare and Institutions Code, § 300 et seq.) electronic form ã 2005 WWW.LawCA.co m Law Publishers JV-100 [Rev. January 1, 2007] § 300 § 342 § 387 JV-100 CHILD'S NAME: CASE NUMBER: ––––– ––––– 2. Petitioner requests that the court find these allegations to be true. I declare under penalty of perjury under the laws of the State of California that the foregoing and all attachments are true and correct. Date: ––––– (TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER) Address and telephone number: Number of pages attached: ––––– Other children are listed on Additional Children Attachment (form JV-101) — NOTICE — TO PARENT Your parental rights may be permanently terminated. To protect your rights, you must appear in court and answer this petition. TO PARENTS OR OTHERS LEGALLY RESPONSIBLE FOR THE SUPPORT OF THE CHILD You and the estate of your child may be jointly and severally liable for the cost of the care, support, and maintenance of your child in any placement or detention facility, the cost of legal services for you or your child by a public defender or other attorney, and the cost of supervision of your child by order of the juvenile court. JV-100 [Rev. January 1, 2007] JUVENILE DEPENDENCY PETITION (VERSION ONE) Page 2 of 2 ( Welfare and Institutions Code, § 300 et seq) § 300 § 342 § 387