JV-569 1 Your name: Proof of Service -- Request for Disclosure Clerk stamps date here when form is filed. Relationship to child (if any): Street address: City: Telephone number: Lawyer (if any) (name, address, telephone numbers, and State Bar number): Fill in court name and street address: State: Zip: Superior Court of California, County of 2 I was not able to provide notice of this petition to the following because I did not know their names or addresses. If this is a Fill in case number if known: request for the case file of a living child, the clerk must serve a copy Case Number: of the petition. If this is a request for the case file of a deceased child, the custodian of records must serve a copy of the petition. a. County counsel or other attorney representing the child welfare agency if petition filed under section 300 b. District attorney if petition filed under section 601 or 602 c. Child Attorney of record for the child d. Child's parent e. Child's legal guardian f. g. h. i. j. Probation department if petition filed under section 601 or 602 Child welfare agency/custodian of records if petition filed under section 300 Child's identified Indian tribe Child's CASA volunteer 3 Copies of Request for Disclosure of Juvenile Case File (JV-570), Notice of Request for Disclosure of Juvenile Case File (JV-571), and a blank Objection to Release of Juvenile Case File (JV-572) have been placed in a sealed envelope with postage paid and deposited in the United States mail addressed to the following: a. County counsel or other attorney representing the child welfare agency if petition filed under section 300 (name and address): Date mailed: or Personally served on (date): Judicial Council of California, www.courtinfo.ca.gov New January 1, 2009, Mandatory Form Welfare and Institutions Code, � 827 California Rules of Court, rules 5.552, 5.553 Proof of Service --Request for Disclosure JV-569, Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com Case Number: Your name: b. District attorney if petition filed under section 601 or 602 (name and address): Date mailed: c. Child (name and address): or Personally served on (date): Date mailed: d. or Personally served on (date): Attorney of record for the child (name and address): Date mailed: e. Child's parent (name and address): or Personally served on (date): Date mailed: f. Child's parent (name and address): or Personally served on (date): Date mailed: g. Child's legal guardian (name and address): or Personally served on (date): Date mailed: or Personally served on (date): h. Probation department if petition filed under section 601 or 602 (name and address): Date mailed: or Personally served on (date): New January 1, 2009, Mandatory Form Proof of Service --Request for Disclosure JV-569, Page 2 of 3 Case Number: Your name: i. Child welfare agency/custodian of records if petition filed under section 300 (name and address): Date mailed: j. or Personally served on (date): The Indian child's tribal representative (name and address): Date mailed: k. or Personally served on (date): The child's CASA volunteer (name and address): Date mailed: or Personally served on (date): 4 I declare under penalty of perjury under the laws of the State of California that the information in this form is true and correct. This means that if I lie on this form, I am guilty of a crime. Date: Type or print your name Sign your name New January 1, 2009, Mandatory Form Proof of Service--Request for Disclosure JV-569, Page 3 of 3