Declaration Submitted By: NAME OF DECLARANT: OFFICE/AGENCY/COURT: STREET ADDRESS: CITY, STATE: TELEPHONE NUMBER: EMAIL ADDRESS: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF EL DORADO Sitting as the Juvenile Court 295 Fair Lane Placerville, CA 95667 1354 Johnson Blvd. South Lake Tahoe, CA 96150 NAME OF MINOR DECLARATION FOR ACCESS TO JUVENILE CASE FILE IN POSSESSION OF JUVENILE COURT (Welfare & Institutions Code § 827, California Rules of Court, rule 5.552) DATE OF BIRTH CASE NUMBER: I,________________________________________, do hereby declare that I am a person described in Welfare and Institutions Code section 827(a)(1)(A)-(0), to wit: A. Persons entitled to inspect and receive copies of juvenile case files: 1. Juvenile court personnel. [WIC § 827(a)(1)(A)] 2. A district attorney, city attorney, or city prosecutor authorized to prosecute criminal or juvenile cases under state law. [WIC § 827(a)(1 )(B) 3. The minor who is the subject of the juvenile proceeding. [WIC § 827(a)(1)(C)] 4. A parent or guardian of the minor. [WIC § 827(a)(1 )(D)] 5. An attorney for the minor who is actively participating in criminal or juvenile proceedings involving the minor. [WIC § 827(a)(1 )(E)] 6. An attorney for the parent or guardian of the minor who is actively participating in criminal or juvenile proceedings involving the minor. [WIC § 827(a)(1)(E)] 7. An attorney representing the petitioning agency in a dependency action. [WIC § 827(a)(1 )(E) & (F)] 8. A judge, referee, or hearing officer who is actively participating in criminal or juvenile proceedings involving the minor. [WIC § 827(a)(1 )(E)] 9. A probation officer actively participating in criminal or juvenile proceedings involving the minor. [WIC § 827(a)(1)(E)] 10. A social worker or investigator employed by a child protective agency. [WIC §§ 272(a)(1} & 827(a)(1)(E) & (H)] 11. A law enforcement officer, other than a deputy sheriff or city police officer, who is actively participating in criminal or juvenile proceedings involving the minor. [WIC § 827(a)(1)(E)] 12. A deputy sheriff or city police officer. [WIC § 827(a)(1)(H) & PC § 11165.9] 13. A probation officer who receives mandated reports of suspected child abuse or neglect pursuant to county designation. [WIC § 827(a)(1)(H) & PC § 11165.9] 14. A State Department of Social Services employee engaged in the oversight and monitoring of county child welfare agencies, children in foster care or receiving foster care assistance, and/or out-of-state placements. [WIC § 827(a)(1)(l)] 15. Court Appointed Special Advocate (CASA) [WIC §§ 827(a)(1)(A) & 103(h)] Eff. 01/01/2017 Mandatory Use DECLARATION FOR ACCESS TO JUVENILE CASE FILE IN POSSESSION OF JUVENILE COURT Page 1 of 2 Local Form J-16 American LegalNet, Inc. www.FormsWorkFlow.com Declarant Name: ______________________________________________ Case Number: _________________ B. Persons entitled to inspect juvenile case files (no copies): 1. A superintendent or designee of the school district where the minor is enrolled or attending school. [WIC § 827(a)(1)(G)] 2. A State Department of Social Services legal staff or special investigator peace officer engaged in the inspection, licensing and investigation of community care facilities. [WIC § 827(a)(1)(J)] 3. A person, agency, or member of a multidisciplinary team providing treatment or supervision of the minor. [WIC § 827(a)(1)(K)] 4. A judge, commissioner, or hearing officer assigned to a family law case involving the custody and/or visitation of the minor. [WIC § 827(a)(1)(L)] 5. A family court mediator actively participating in a family law case involving the minor. [WIC § 827(a)(1)(L)] 6. A child custody evaluator actively participating in a family law case involving the minor. [WIC § 827(a)(1)(L)] 7. An attorney appointed for the minor in a family law case. [WIC § 827(a)(1 )(L)] 8. A probate court investigator actively participating in a guardianship case involving the minor. [WIC § 827(a)(1)(M)] 9. A local child support agency employee engaged in establishing paternity and/or establishing and enforcing child support orders. [WIC § 827(a)(1)(N)] 10. A juvenile justice commissioner appointed pursuant to Welfare and Institutions Code § 225. [WIC § 827(a)(1)(O)] I further declare: C. I am requesting to view and/or receive copies of the juvenile case file concerning the above-named minor for use in my capacity described above, and will not share any portion of the records released to [Initial] me or information relating to their contents, other than as provided by law. D. I will not attach any portion of the juvenile case file or any information relating to the contents of the juvenile case file to any other document without the prior approval of the Presiding Judge of the Juvenile Court, unless they are used in connection with and in the course of a criminal investigation, a proceeding to declare a person a dependent child or ward of the Juvenile Court, or a proceeding described in Welfare and Institutions Code section 827(a)(1)(I) by the State Department of Social Services. [Initial] Designation of Authorized Agent: I authorize _______________________________________________ as my agent to view and/or receive copies of the requested records. E. I declare under penalty of perjury that the above is true and correct. Executed this ______ day of _______________________ , 20 ____ in _________________________, California. ____________________________________________ Signature _______________________________________ Print Title The Court orders persons who inspect records or receive copies of records not to disseminate the contents, other than as provided by law in Welfare and Institutions Code section 827(a)(1). STATE BAR NO: If applicable, please indicate: BADGE NO. (LAW ENFORCEMENT): AGENCY CASE NO: RELATED (NON-JUVENILE) CASE NO.: FOR COURT OR AGENCY USE ONLY GRANTED Date: Name: DENIED Eff. 01/01/2017 Mandatory Use DECLARATION FOR ACCESS TO JUVENILE CASE FILE IN POSSESSION OF JUVENILE COURT American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Local Form J-16