San Francisco — Authorization for the Appointment of

Superior Court of California, County of San Francisco UNIFIED FAMILY COURT JUVENILE DEPENDENCY

Authorization for Funds for Appointment of Private Social Worker

IN THE MATTER OF:

Case Number:

(Defendant/Minor)

GOOD CAUSE APPEARING, IT IS HEREBY ORDERED that public funds be provided on application

by attorney, _________________________________, for the purpose of retaining a private social

worker in the above captioned matter, said funds not exceed $ _______________________.

SUMMARY OF SOCIAL WORKER TASKS:

Attorney Signature Commissioner/Judge of the Superior Court

Dated: Dated:

ORDER FOR PAYMENT OF COMPENSATION

IT IS HEREIN ORDERED that a warrant for the sum of $ ______________, payable out of the

general fund of the City and County of San Francisco be drawn by the City and County of San Francisco in favor of:

NAME:

SOCIAL SECURITY NO.:

ADDRESS:

CITY/STATE/ZIP CODE:

TELEPHONE:

FAX:

Dated: Attorney Signature

Date:

Commissioner/Judge of the Superior Court

NOTE: Please submit one (1) original and two (2) copies of the order with copies of invoice and any additional attachments.

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AUTHORIZATION FOR FUNDS FOR APPOINTMENT OF PRIVATE SOCIAL WORKER

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San Francisco — Authorization for the Appointment of Private Social Worker¶