Santa Clara — JV-2002a*

Source: https://santaclara.courts.ca.gov/system/files/jv-2002a_0.pdf

ATTACHMENT JV-2002a ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: FOR COURT USE ONLY To keep other people from seeing what you entered, please press the Reset Form ATTORNEY FOR (Name): button at the end of the form when finished. SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA Street Address: 115 Terraine Street, San José, CA 95113 Mailing Address: 191 North First Street, San José, CA 95113 Branch Name: Juvenile Dependency

In the Matter of: (Name of Child), a Minor. [D.O.B. _________ ]

CASE NUMBER:

DECLARATION FOR JUVENILE COURT RECORD (DEPENDENCY)

I am:

1. Child or Former Dependent

2. Mother of the named juvenile (name, “AKA” and DOB)

3. Father of the named juvenile (name, “AKA” and DOB)

4. Guardian of the named juvenile (name, “AKA” and DOB)

5. Court-Appointed Special Advocate (CASA)

6. District Attorney - State Bar Number:

7. Attorney - State Bar Number: Representing:

8. Sixth Appellate District Program Member

9. Other: (specify)

10. Address:

11. I am requesting to view the following record(s) relating to the minor:

12. Which are held by:

    a. Court Clerk, Juvenile Dependency Division

    b. Department of Family & Children Services

13. I request copies of the following record(s) [copies of records may be subject to a fee pursuant to statute]:

Use of juvenile records is subject to Petition under Welfare & Institutions Code § 827 [JV-570] and further Court authorization. I understand these records are confidential.

I declare under penalty of perjury the forgoing is true and correct.

Dated this day of , 20 , at San José, California

Signature:

Type or print name:

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JV-2002a REV. 07/01/13 DECLARATION FOR JUVENILE COURT RECORD Page 1 of 1 (DEPENDENCY)