RECORD SEALING LIST OF AGENCIES ATTACHMENT PAGE Minor: DOB: Date Petition Filed: If there are multiple petitions ordered sealed, a separate Records Sealing List of Agencies form should be completed for each petition. Court Case Number: Date of Order: Sealing is Ordered pursuant to: 786 WIC 793(c) WIC 781 WIC Date of Arrest: Crime Report /Incident Number: TO THE CUSTODIAN OF RECORDS: The Court has ordered each agency listed below to seal the records in its custody as directed by the order. If sealing is ordered under WIC §§ 781 or 786, the agencies listed below shall advise the Court of its compliance with the sealing order. A blank Acknowledgment of Juvenile Records Sealed form is provided for your convenience. Please return the completed acknowledgement to the Court. Department of Justice P.O. Box 903417 Sacramento, CA 94203-4170 Riverside Superior Court ­ Juvenile Division Riverside County Probation Department Riverside County District Attorney Law Enforcement Agency Law Enforcement Agency Department of Motor Vehicles P.O. Box 942890 Sacramento, CA 94290-0001 Page 1 of 1 Approved for Optional Use Riverside Superior Court RI-JV019 [Rev. 01/01/16] RECORD SEALING LIST OF AGENCIES ATTACHMENT PAGE riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com