Superior Court of California, County of Yuba Effective January 1, 2013 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address) FOR COURT USE ONLY TELEPHONE NO: ATTORNEY FOR (NAME): FAX NO: SUPERIOR COURT OF CALIFORNIA COUNTY OF YUBA 215 FIFTH STREET, SUITE 200 MARYSVILLE, CA 95901 (530) 749-7600 Guardianship/Conservatorship of: Minor/Conservatee. CASE NUMBER: PETITION FOR: VISITATION REVIEW HEARING OTHER I, ___________________________, hereby petition the Court for the following: My relationship to the minor/conservatee is: mother other (specify) _____. father grandparent aunt/uncle sibling My petition is based on the following reasons (explain in detail): Continued on attachment. I declare under penalty of perjury that the foregoing is true and correct, and that this petition was executed on _____________________, 20____, at , State of California. _________________________________ Type or Print Name _________________________________________ Signature of Petitioner _________________________________ Type or Print Name _________________________________________ Signature of Petitioner ________________________________________________________________________________________________ - 72 American LegalNet, Inc. www.FormsWorkFlow.com