On (date of application):, applicant applied by affidavit to a social worker to commence proceedings based on the allegations described above. (Attach a copy of the Application to Commence Proceedings, form JV-210.)Applicant on information and belief alleges that the child below is at risk of abuse or neglect and should come within the jurisdiction of the court (supply all information known):4.The child described in item 3 abovea. Form Approved for Optional Use Judicial Council of California JV-212 [Rev. September 1, 2018]APPLICATION TO REVIEW DECISION BY SOCIAL WORKER NOT TO COMMENCE PROCEEDINGS (Welf. & Inst. Code, 247 331)Welfare and Institutions Code, 247 331Applicant's name and address:resides within this county. SUPERIOR COURT OF CALIFORNIA, COUNTY OFSTREET ADDRESS:MAILING ADDRESS:CITY AND ZIP CODE:BRANCH NAME: CHILD'S NAME: APPLICATION TO REVIEW DECISION BY SOCIAL WORKER NOT TO COMMENCE PROCEEDINGS (Welf. & Inst. Code, 247 331) FOR COURT USE ONLY CASE NUMBER:JV-212 ATTORNEY OR PARTY WITHOUT ATTORNEYSTATE BAR NUMBER:NAME:FIRM NAME:STREET ADDRESS:CITY:STATE:ZIP CODE:TELEPHONE NO.:FAX NO.:E-MAIL ADDRESS:ATTORNEY FOR (name):1. Applicant's relationship to child (specify):2.3.Child's name:b.Age:c.Date of birth:d.Sex:e.Mother's name:f.Mother's address:g.Father's name:h.Father's address:i.Other (state name, address, and relationship to child):a.was in this county at the time of the facts alleged below. b.5.Facts in support (State supporting facts concisely; include all known and relevant dates, times, names, and addresses. Attachseparate pages as necessary.): See attachment 5.6.7.It has been three weeks since the application to commence proceedings, and no petition to commence proceedings has been filedby the social worker on behalf of this child.8.Applicant now requests the juvenile court review the decision of the social worker, and issue an order compelling the social workerto commence juvenile court proceedings. (SIGNATURE OF APPLICANT) Date: (TYPE OR PRINT NAME) THE COURT FINDS AND ORDERS9.The court has reviewed the application and orders thatthe social worker is hereby ordered to commence proceedings by filing a petition pursuant to Welfare and InstitutionsCode section 300 based on the allegations set forth in the application. b.the decision of the social worker not to commence proceedings is affirmed. a.Date:JUDICIAL OFFICER American LegalNet, Inc.