IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of (use child's initials only): A minor under 18 years of age. Date of Birth: ) ) ) ) ) ) CASE NO. REQUEST FOR REVIEW HEARING ON VISITATION I am a parent, an adult family member, or the guardian of the minor child named above. The Office of Children's Services has denied me reasonable visitation with the child. As an interested person, I ask the court for a review hearing on this matter. I understand that I am not eligible for publicly appointed legal counsel. Date I certify that on I sent copies of this request to: City Clerk: Signature Type or Print Name Mailing Address State & ZIP Daytime Phone Number ORDER IT IS ORDERED that the request for review hearing is DENIED. Good cause for a review hearing has not been demonstrated. GRANTED. A review hearing will be held on a.m./p.m., at at Date Judge I certify that on I sent copies of this order to: Type or Print Name Clerk: CN-365 (1/06)(cs) REQUEST FOR REVIEW HEARING ON VISITATION AS 47.10.080(p) American LegalNet, Inc. www.FormsWorkflow.com