MJV-100 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional) SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NUMBER: HEARING DATE: PETITIONER/PLAINTIFF: TIME: RESPONDENT/DEFENDANT: DEPT.: CERTIFICATION OF ATTORNEY COMPETENCY , am an Attorney at law licensed to Name Office Address Telephone Number practice in the State of California. My State Bar Number is . I hereby certify that I meet the minimum standards for practice before a Juvenile Court set forth in California Rules of Court, rule 5.660, and local rule 16.19 and that I have completed the minimum requirements for training, education and/or experience as set forth below. Training and Education: (Attach copies of MCLE certificates or other documentation of attendance) Course Title Date Completed Hours Provider I, Summary of Juvenile Dependence Experience: Dated: Signature In RE: Case No: Certification of Attorney Competency Dated: MJV-100 (rev 010117) American LegalNet, Inc. www.FormsWorkFlow.com