TO BE FILED IN THE COURT OF APPEAL JV-825 Court of Appeal Case Number (court will provide): COURT OF APPEAL, APPELLATE DISTRICT, DIVISION (FILE STAMP) In re the Matter of: (Name and date of birth of subject child or children) Petitioners v. Superior Court No. Superior Court of California, County of Superior Court No. Respondent Related Appeal Pending Appellate Court No. Real Party in Interest PETITION FOR EXTRAORDINARY WRIT (California Rules of Court, Rules 8.452, 8.456) STAY REQUESTED (see item 11). INSTRUCTIONS—READ CAREFULLY • Read the entire form before completing any items. • This petition must be clearly handprinted in ink or typed. • Complete all applicable items in the proper spaces. If you need additional space, add an extra page and mark the additional page box. • If you are filing this petition in the Court of Appeal, file the original and 4 copies. • If you are filing this petition in the California Supreme Court, file the original and 10 copies. • Notify the clerk of the court in writing if you change your address after filing your petition. Individual Courts of Appeal or the Supreme Court may require documents other than or in addition to this form. Contact the clerk of the reviewing court for local requirements. Page 1 of 3 Form Approved for Optional Use Judicial Council of California JV-825 [Rev. July 1, 2010] PETITION FOR EXTRAORDINARY WRIT (California Rules of Court, Rules 8.452, 8.456) Welfare and Institutions Code, §§ 366.26, 366.28; Cal. Rules of Court, rules 8.452, 8.456 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com JV-825 CASE NAME: CASE NUMBER: 1. This Petition for Extraordinary Writ (Juvenile Dependency) is filed on behalf of petitioner. a. Name: b. Address: c. Phone number: 2. Petitioner is the a. child b. mother c. father d. guardian e. f. g. h. de facto parent county welfare department district attorney other (state relationship to child or interest in the case): 3. The Petition for Extraordinary Writ (Juvenile Dependency) pertains to the following child or children (specify number of children): a. Name of child: Child's date of birth: b. Name of child: Child's date of birth: c. Name of child: Child's date of birth: d. Name of child: Child's date of birth: Continued in Attachment 3. 4. This petition seeks extraordinary relief from the order of (name): a. setting a hearing under Welfare and Institutions Code section 366.26 to consider termination of parental rights, guardianship, or another planned permanent living arrangement. b. c. OR designating a specific placement after a placement order under Welfare and Institutions Code section 366.28. OR other (specify): 5. The challenged order was made on (date of hearing): 6. The order was erroneous on the following grounds (specify): 7. a. b. Supporting documents are attached. Because of exigent circumstances, supporting documents are not attached (explain): 8. Summary of factual basis for petition (Petitioner need not repeat facts as they appear in the record. Petitioner must reference each specific portion of the record, its significance to the grounds alleged, and disputed aspects of the record): Additional pages attached. JV-825 [Rev. July 1, 2010] PETITION FOR EXTRAORDINARY WRIT (California Rules of Court, Rules 8.452, 8.56) Page 2 of 3 JV-825 CASE NAME: CASE NUMBER: 9. Points and authorities in support of the petition are attached (number of pages attached): 10. Petitioner requests that this court direct the trial court to (check all that apply): a. Vacate the order for hearing under section 366.26. b. Vacate the order designating a specific placement after termination of parental rights under section 366.28. c. d. Remand for hearing. Order that reunification services be provided continued. Order visitation between the child and petitioner. Return or grant custody of the child to petitioner. Terminate dependency. Other (specify): e. f. g. h. 11. Petitioner requests a temporary stay pending the granting or denial of the petition for extraordinary writ. a. Hearing date (must specify): b. Reasons for stay (specify): Additional pages attached. 12. Total number of pages attached: 13. I am the petitioner attorney for petitioner. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, except for matters that are stated on my information and belief, and as to those matters, I believe them to be true. Date: (TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER ATTORNEY) Address: JV-825 [Rev. July 1, 2010] PETITION FOR EXTRAORDINARY WRIT (California Rules of Court, Rules 8.452, 8.456) Page 3 of 3