Stanislaus — De Facto Parent Request

Source: https://www.stanislaus.courts.ca.gov/system/files/forms-and-filings/jv-295-de-facto-parent-form-packet.pdf

JV-295 De Facto Parent Request Clerk stamps date here when form is filed.

The address of any licensed foster family home must remain
confidential unless the judge or the foster parent authorizes release of
the address. Court clerks should not send this page to the parties
without a court order or authorization of the foster parent. (Welf. &
Inst. Code, § 308(a).)

1 My/Our name(s):

Fill in court name and street address:
My/Our address: Superior Court of California, County of
Stanislaus
City: State: Zip:
2215 Blue Gum Avenue, Room 15 My/Our phone #: Modesto, CA 95358
Juvenile Division
2 I am/We are asking that I/we be appointed de facto parent(s) of
Court fills in case number when form is filed.
(Child’s name): Case Number:

Date:
Type or print your name Signature of person requesting de facto parent status

Date:
Type or print your name Signature of person requesting de facto parent status

Date:
Type or print attorney’s name Signature of attorney (if applicable)

Attorney’s address:
City: State: Zip:
Attorney’s phone #:

NOTICE
If you are not the child, child’s parent, or child’s legal guardian, you may have a right to challenge a decision by the
juvenile court, but only in very limited circumstances. You may need a court order granting you access to records in the
juvenile case file. For more information, please see Information on Requesting Access to Records for Persons With a
Limited Right to Appeal (form ). You can get form at any courthouse or county law library
or online at

Judicial Council of California, www.courts.ca.gov
Rev. September 1, 2020, Mandatory Form De Facto Parent Request JV-295, Page 1 of 1
Cal. Rules of Court, rule 5.534(a)

JV-291-INFOJV-291-INFOwww.courts.ca.gov/forms.

Clerk stamps below when form is filed. JV-296 De Facto Parent Statement

1 My/Our name(s):

2 The child’s name: Boy Girl 3 Child’s date of birth: Age: Relationship to child (grandparent, foster parent, etc.): Court name and street address:

Superior Court of California, County of Stanislaus

4 The child has lived with me from: 2215 Blue Gum Avenue, Room 15 (date) to (date) Modesto, CA 95358 Juvenile Division (date) to (date)

5 I have had responsibility for the day-to-day care of the child Case Number: from: (date) to (date) (date) to (date)

6 Information the judge should know about my relationship with the child. (This part must be completed).

a. Amount of time I spend with the child (daily, weekly, etc.): d. I have have not attended
court hearings about the child.

e. I have have not sent a written
report to the court about the child.
b. Activities I do with the child:

c. Kinds of information I have about the child that others may not have (medical, educational, behavioral, etc.):

7 I declare under penalty of perjury under the laws of the State of California that the information on this form is true and correct to my knowledge. This means if I lie on this form, I am committing a crime.

Date:
Type or print your name Signature of person requesting de facto parent status

Date:
Type or print your name Signature of person requesting de facto parent status

Judicial Council of California‚ www.courtinfo.ca.gov JV-296, Page 1 of 1Revised January 1, 2007, Mandatory Form De Facto Parent Statement Cal. Rules of Court‚ rule 5.534(e)

Clerk stamps date here when form is filed. JV-297 De Facto Parent Order

COURT WILL FILL OUT SECTION BELOW

The judge, after reading and reviewing the De Facto Parent Request and the De Facto Parent Statement filed by (Name): (Name): Court name and street address: Superior Court of California, County of asking to be appointed the de facto parent(s) of Stanislaus (Child’s name): 2215 Blue Gum Avenue, Room 15 orders: Modesto, CA 95358 Juvenile Division

1. The request for de facto parent status is granted. Case Number: 2. The request for de facto parent status is denied.
2. The judge orders a hearing on the request for de facto parent status.

The hearing will take place on
at a.m./p.m. in Department:

of the Superior Court located at

The court does does not appoint a lawyer to represent the de facto parent.

The lawyer’s name is: (print name)

Date: Judge (or Judicial Officer)

This is a Court Order.

Judicial Council of California, www.courts.ca.gov JV-297, Page 1 of 1Revised September 1, 2019, Mandatory Form De Facto Parent Order Cal. Rules of Court, rules 5.534(a) and 5.502(10)

JV-287 Confidential Information Clerk stamps date here when form is filed.

This form is used to keep contact information confidential. It may be used along with any Judicial Council juvenile form, including Request to Change Court Order (form JV-180), Application and Affidavit for Restraining Order (form JV-245), Relative Information (form JV-285), Caregiver Information Form (form JV-290), De Facto Parent Request (form JV-295), and Position on Release of Information to Medical Board of California (form JV-228).

You do not need to fill out this entire form. Write only the information that you know. Fill in court name and street address: Superior Court of California, County of This information must be kept under seal in the court file. Only the court, the Stanislaus agency, and the child's attorney may look at this information. 2215 Blue Gum Avenue, Room 15 Modesto, CA 95358 1 Your name: Juvenile Division Your telephone number: Your address: Fill in child’s name and date of birth: Child’s Name:

Date of Birth:

Court fills in case number when form is filed.

2 Child’s name: Case Number: Child’s telephone number, if known:

Child’s address, if known:

3 If known: Child’s Indian custodian, if any (name each): Custodian’s telephone number:

Custodian’s address:

4 If known: Child’s caregiver (name each): Caregiver’s telephone number:

Caregiver’s address:

Judicial Council of California, www.courts.ca.gov Rev. September 1, 2020, Optional Form Confidential Information JV-287, Page 1 of 1 California Rules of Court, rule 5.534