JV-420 CHILD'S NAME: CASE NUMBER: DISPOSITIONAL ATTACHMENT: REMOVAL FROM CUSTODIAL PARENT--PLACEMENT WITH PREVIOUSLY NONCUSTODIAL PARENT (Welf. & Inst. Code, §§ 361, 361.2) 1. The child is a person described under Welf. & Inst. Code, § 300 (check all that apply): 300(a) 300(c) 300(e) 300(g) 300(i) 300(b) 300(d) 300(f) 300(h) 300(j) and is adjudged a dependent of the court. Circumstances justifying removal from custodial parent 2. There is clear and convincing evidence of the circumstances stated in Welf. and Inst. Code, § 361 regarding the persons specified below (check all that apply): 361(c)(1) 361(c)(2) 361(c)(3) 361(c)(4) 361(c)(5) a. b. c. d. e. f. Mother Presumed father Biological father Legal guardian Indian custodian Other (specify): 3. The child is may be an Indian child, and, by clear and convincing evidence, including the testimony of a qualified expert witness, continued physical custody by the following person is likely to cause the child serious emotional or physical damage: mother presumed father other (specify): biological father Indian custodian legal guardian 4. Reasonable efforts 5. The child a. b. is were were not may be made to prevent or eliminate the need for the child's removal from the home. an Indian child, and, by clear and convincing evidence, active efforts were made to provide remedial services and rehabilitative programs designed to prevent the breakup of this Indian family, and those efforts were unsuccessful. active efforts were not made to provide remedial services and rehabilitative programs designed to prevent the breakup of this Indian family. 6. Based on the facts stated on the record, continuance in the home is contrary to the child's welfare and physical custody of the child is removed from (check all that apply): mother presumed father Family finding and engagement 7. a. b. The county agency has made diligent efforts to identify, locate, and contact the child's relatives. The county agency has not made diligent efforts to identify, locate, and contact the child's family members. (1) (2) The county agency is ordered to make such diligent efforts, except for individuals the agency has determined to be inappropriate to contact because of their involvement with family or domestic violence. The county agency must submit a report to the court on or before (date): detailing the diligent efforts made and the results of such efforts. Page 1 of 3 Form Approved for Optional Use Judicial Council of California JV-420 [Rev. July 1, 2011] biological father Indian custodian legal guardian other (specify): DISPOSITIONAL ATTACHMENT: REMOVAL FROM CUSTODIAL PARENT--PLACEMENT WITH PREVIOUSLY NONCUSTODIAL PARENT (Welf. & Inst. Code, §§ 361, 361.2) Welfare and Institutions Code, §§ 361, 361.2; Cal. Rules of Court, rules 5.651 and 5.695 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com JV-420 CHILD'S NAME: CASE NUMBER: Case plan development 8. a. b. The county agency solicited and integrated into the case plan the input of the representative of child's identified Indian tribe other (specify): The county agency did not solicit and integrate into the case plan the input of the other (specify): representative of child's identified Indian tribe The county agency did not solicit and integrate into the case plan the input of the representative of child's identified Indian tribe other (specify): child child mother mother father . father , father , and the agency is ordered to do so and submit an updated case plan within 30 days of the date of this hearing. c. child mother and the county agency is not required to do so because these persons are unable, unavailable, or unwilling to participate. Custody of the child and services 9. a. The mother presumed father biological father was not residing with the child at the time that the events or conditions arose that brought the child within the provisions of Welf. & Inst. Code, § 300 and desires custody of the child. Placement with this parent would not be detrimental to the safety, protection, or physical or emotional well-being of the child. The child is placed with this parent. b. The parent indicated in item 9a is granted physical and legal custody of the child under the custody order and final judgment entered this day. Visitation with the child is as stated in the Visitation Order--Juvenile (form JV-205). The clerk of the juvenile court must file with the family court a completed Custody Order--Juvenile--Final Judgment (form JV-200) and Visitation Order--Juvenile (form JV-205). Jurisdiction of the court is terminated. The parent indicated in item 9a is granted custody of the child subject to the jurisdiction of the juvenile court. The county agency must conduct a home visit within three months and file a report with the court. The parent indicated in item 9a is granted custody of the child subject to the supervision of the juvenile court. (1) Family maintenance services are to be provided to the parent indicated in item 9a to allow that parent to retain later custody without court supervision. The parent is ordered to participate in the services stated in the case plan. Reunification services are not ordered for the person from whom the child was removed. Reunification services are provided to the person from whom the child was removed, the biological father mother presumed father who is ordered to participate in the services stated in the case plan. Family maintenance services are not ordered for the parent indicated in item 9a. (3) Reunification services are provided to the person from whom the child was removed, the biological father mother presumed father and family maintenance services are to be provided to the parent indicated in item 9a. The parents are ordered to participate in the services stated in the case plan. The court will determine at a scheduled court hearing which parent, if either, will have custody of the child without court supervision. 10. The factual basis for the findings and orders in item 9 is stated on the record. c. d. (2) Siblings 11. 12. The child does not have siblings under the court's jurisdiction. The child has siblings under the court's jurisdiction. Sibling Attachment: Contact and Placement (form JV-403) is attached and incorporated by reference. JV-420 [Rev. July 1, 2011] DISPOSITIONAL ATTACHMENT: REMOVAL FROM CUSTODIAL PARENT-- PLACEMENT WITH PREVIOUSLY NONCUSTODIAL PARENT (Welf. & Inst. Code, §§ 361, 361.2) Page 2 of 3 JV-420 CHILD'S NAME: CASE NUMBER: Education 13