JV-822 ATTORNEY OR PARTY WITHOUT ATTORNEY: NAME: FIRM NAME: STREET ADDRESS: CITY: TELEPHONE NO.: E-MAIL ADDRESS: ATTORNEY FOR (name): STATE: FAX NO.: ZIP CODE: STATE BAR NO.: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NAME: NOTICE OF INTENT TO FILE WRIT PETITION AND REQUEST FOR RECORD TO REVIEW ORDER DESIGNATING OR DENYING SPECIFIC PLACEMENT OF A DEPENDENT CHILD AFTER TERMINATION OF PARENTAL RIGHTS (California Rules of Court, Rule 8.454) CASE NUMBER: NOTICE The juvenile court has ordered or denied a specific placement for this child. If you want an appeals court to review the juvenile court's decision, you must first tell the juvenile court by filing a Notice of Intent. You may use this form as your Notice of Intent. In most cases, you have only 7 days from the court's placement decision to file a Notice of Intent. Please see page 2 for your specific deadline for filing this form. 1. Petitioner's name: 2. Petitioner's address: 3. Petitioner's phone number: 4. Petitioner is a. b. c. d. e. child's caretaker (specify dates in your care): child county welfare department legal guardian other (state relationship to child or interest in the case): Child's date of birth: the juvenile court terminated parental rights under Welfare and Institutions Code 5. Child's name: 6. a. On (date): section 366.26. b. On (date): the court made a specific placement order or denied a specific placement request that the dependent child is to reside in, be retained in, or be removed from a specific placement. Petitioner intends to file a writ petition to challenge the specific placement order or the denial of a specific placement request made by the court on that date and requests that the clerk assemble the record. Date: (TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER CHILD'S ATTORNEY) The Notice of Intent to File Writ Petition must be signed by the person intending to file the writ petition, or, if it is to be filed on behalf of the child, by the child's attorney of record. See the back of this form for more information. PLEASE READ THE BACK OF THIS FORM FOR IMPORTANT INFORMATION AND DEADLINES Page 1 of 2 Form Adopted for Optional Use Judicial Council of California JV-822 [Rev. January 1, 2017] NOTICE OF INTENT TO FILE WRIT PETITION AND REQUEST FOR RECORD TO REVIEW ORDER DESIGNATING OR DENYING SPECIFIC PLACEMENT OF A DEPENDENT CHILD AFTER TERMINATION OF PARENTAL RIGHTS (California Rules of Court, Rule 8.454) Welfare and Institutions Code, � 366.28 Cal. Rules of Court, rule 8.454; www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com JV-822 HOW DO I CHALLENGE THE COURT'S PLACEMENT DECISION AFTER TERMINATION OF PARENTAL RIGHTS? � File this Notice of Intent to File Writ Petition and Request for Record in the juvenile court within the time listed below in the next box. This will let the court know you intend to file a writ petition, and the court will prepare the record. � You will be notified after the record is filed in the Court of Appeal, and you will get a copy of the record. You have 10 days after the record is filed in the Court of Appeal to file and serve your writ petition. � You may use the optional Judicial Council form JV-825 to complete your writ petition, or, if you have an attorney, your attorney can write the writ petition for you. � After you file a writ petition in the Court of Appeal you must send a copy of the petition to all of the parties in the case, to the child's CASA volunteer, to the child's present caregiver, and to any de facto parent who has standing to participate in the juvenile court proceedings. SEE CAL. RULES OF COURT, RULES 8.454�8.456 WHEN DO I HAVE TO FILE MY NOTICE OF INTENT TO FILE WRIT PETITION AND REQUEST FOR RECORD? � If you were present when the court granted or denied the specified placement, you must file the Notice of Intent within 7 days from the date the court granted or denied the specified placement. � If you were not present in court but were given notice by mail of the court's decision to grant or deny the specified placement, you must file the Notice of Intent within 12 days from the date the clerk mailed the notification. � If the order granting or denying the specific placement was made by a referee not acting as a temporary judge, you must file the Notice of Intent within 17 days from the date the court set the hearing. SIGNATURE ON NOTICE OF INTENT � Must be signed by the person who intends to file the writ petition, or � If petition will be filed on behalf of a child, by the child's attorney, or � The reviewing court may waive this requirement for good cause on the basis of a declaration by the attorney of record explaining why the party could not sign the notice. (Cal. Rules of Court, rule 8.450(e)(3).) JV-822 [Rev. January 1, 2017] NOTICE OF INTENT TO FILE WRIT PETITION AND REQUEST FOR RECORD TO REVIEW ORDER DESIGNATING OR DENYING SPECIFIC PLACEMENT OF A DEPENDENT CHILD AFTER TERMINATION OF PARENTAL RIGHTS (California Rules of Court, Rule 8.454) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com