JV-591 AGENCY: NAME: STREET ADDRESS: CITY: TELEPHONE NO.: E-MAIL ADDRESS: STATE: FAX NO.: ZIP CODE: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NAME: CLERK'S USE ONLY CASE NUMBER: ACKNOWLEDGMENT OF JUVENILE RECORD SEALED INSTRUCTIONS: Under Welfare and Institutions Code sections 781 and 786, agencies must advise the court of their compliance with the court's sealing order. Please return this completed Acknowledgment of Juvenile Record Sealed to the court upon sealing of the records. 1. TO THE CLERK OF THE COURT: I certify that the records ordered to be sealed by the court have been sealed and a copy of this acknowledgment of record sealed has been sent to the court advising the court of compliance with its order. 2. Date of Court Order: 3. Child's Name: 4. Agency Name: Date: By: (TYPE OR PRINT YOUR NAME) (SIGNATURE) Page 1 of 1 Form Approved for Optional Use Judicial Council of California JV-591 [New July 1, 2016] ACKNOWLEDGMENT OF JUVENILE RECORD SEALED Welfare and Institutions Code, §§ 781, 786; Cal. Rules of Court, rules 5.830 and 5.840 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com