INSTRUCTIONS TO COMPLETE THE OBJECTION FORM In the Matter of: COURT ORDERED - RESIDENTIAL PLACEMENT FEES THIS FORM IS ONLY FOR THE APPEAL OF COURT ORDERED RESIDENTIAL PLACEMENT FEES AND MUST BE RECEIVED BY THE MARICOPA COUNTY JUVENILE PROBATION DIVISION WITHIN 25 CALENDAR DAYS OF THE DATE THE COURT ORDER WAS FILED. (THE FILING DATE IS LOCATED ON THE UPPER RIGHT CORNER OF THE COURT ORDER.) Match the numbered instructions to the number on the Objection Form. TYPE or PRINT and USE ONLY BLACK INK 1. Name, Address and Phone number of the person filing document. Your phone number should be the number where you can be reached Monday through Friday from 8:00 a.m. to 5:00 p.m. or where a message may be left for you. 2. If you have obtained the service of an attorney, the attorney must provide his/her State Bar number. 3. If you have obtained the service of an attorney, mark attorney and list attorney’s name. Note: It is not necessary to have legal representation for this process. 4. Juvenile’s Name and JV Number. (The JV number is located in the upper left area of the court order) 5. Name of the assessed party. 6. Date that the order for the assessment of residential placement fees was signed by the Court. (located towards the bottom of the court order) 7. Check the box which indicates: If you are requesting a hearing or if you do not request a hearing. 8. Juvenile’s Name and JV Number. (As listed on page 1 - Item #4) 9. Briefly explain why you are objecting to the Court’s Order for the assessment of residential placement fees. 10. Briefly explain your proposed solution to the objection. 11. Your Signature and current date. The Court will keep the original document - Please make a copy for your records RETURN COMPLETED FORM TO Maricopa County Superior Court Maricopa County Superior Court Juvenile Probation Division –Treatment Service Juvenile Probation Division –Treatment Service Resource Specialist Resource Specialist OR 1810 S. Lewis Street Mesa, Arizona 85210 3125 W. Durango Phoenix, Arizona 85009 Distribution: Treatment Service Resource Specialist MARICOPA COUNTY JUVENILE COURT July 21, 2008 ALL RIGHTS RESERVED Page 1 of 1 JVP31i Use Current Version American LegalNet, Inc. www.FormsWorkFlow.com (1) Name of Person Filing Document: Address: State: City: Telephone Number: area code Zip Code: phone FOR CLERK’S USE ONLY (2) Attorney’s Bar Number (if applicable): (3) Representing Self or Attorney for SUPERIOR COURT OF ARIZONA MARICOPA COUNTY JUVENILE PROBATION DIVISION OBJECTION FORM In the Matter of: COURT ORDERED - RESIDENTIAL PLACEMENT FEES (4) Juvenile’s Name: JV Number: (5) I, , object to the Placement Assessment (Name of Assessed Party) Fee as Ordered and entered on the (6) day of , 20_____, by this Court. FURTHER, I request the court to review my objection. (7) I request the court to schedule a hearing. I do not request the court to schedule a hearing. I understand that the court will consider my objection without a formal hearing. JVP31f Maricopa County Juvenile Court July 21, 2008 ALL RIGHTS RESERVED Use Current Version Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Juv Case No. OBJECTION FORM In the Matter of: COURT ORDERED - RESIDENTIAL PLACEMENT FEES Continued (8) Juvenile’s Name: JV Number: (9) The Objection is based upon the following: Attach an additional page if more space is needed (10) Proposed solution to Objection is the following: (Attach an additional page if more space is needed) Respectfully Submitted, (11) Signature Date RETURN COMPLETED FORM TO: Maricopa County Superior Court – Juvenile Probation Division 3125 W. Durango, Phoenix, Arizona 85009 OR 1810 S. Lewis Street, Mesa, Arizona 85210 Distribution: Treatment Service Resource Specialist JVP31f Maricopa County Juvenile Court July 21, 2008 ALL RIGHTS RESERVED Use Current Version Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com