SUPERIOR COURT OF CALIFORNIA · COUNTY OF FRESNO Dependency Department Juvenile Division 3333 East American Avenue, Bldg. 701, Ste. A Fresno, California 93724-0002 (559) APPLICATION TO INSPECT AND/OR COPY JUVENILE CASE FILE GENERAL INFORMATION: Child/Minor's Name: Applicant's Name: Applicant's Relationship to Child/Minor: APPLICATION REQUEST: I am requesting to inspect and/or copy juvenile records concerning the above-named minor that is in Juvenile Delinquency Court The possession of the following organization: Juvenile Dependency Court Parent Date of Birth: Phone Number: Legal Guardian Other: DECLARATION AND STATUTORY BASIS FOR APPLICATION TO INSPECT AND/OR COPY: , do hereby declare that I qualify to inspect and/or copy the documents I, Pursuant to Welfare and Institutions Code Section 827(a)(1) because I am: 1.) The child/minor who is/was the subject of the juvenile case file, whether or not presently over the age of eighteen, but with the consent of the attorney or Guardian Ad Litem (GAL) if under the age of eighteen. W & I Code Section 827(a)(1)(C). A parent or guardian of the child/minor who is the subject of the juvenile case file. W & I Code Section 827(a)(1)(D). A deputy district or city attorney authorized to prosecute criminal or juvenile cases under state law (W & I Code Section 827(a)(1)(B)); or a representative of the Department of Justice, pursuant to W & I Code Section 602.5. Court Personnel: An attorney for the parties, judge, referee, other hearing officer, probation officer, or law enforcement officer who is actively participating in criminal or juvenile proceedings involving the minor. A judge, commissioner, or other hearing officer assigned to a family law case with issues concerning custody or visitation, or both, involving the minor. A family court mediator, actively participating in a family law case involving the minor pursuant to Article 1 (commencing with Section 3160) of Chapter 11 of Part 2 of Division 8 of the Family Code, a court-appointed evaluator or a person conducting a court -connected child custody evaluation, investigation, or assessment pursuant to Section 3111 or 3118 of the Family Code, and counsel appointed for the minor in the family law case (the court clerk may require counsel to provide certified copy of the court order appointing him or her as the minor's counsel). W & I Code Section 827(a)(1)(A) (E) & (L). A Fresno County Deputy County Counsel or any other attorney representing the petitioning agency in a dependency action. W & I Code Section 827(a)(1)(F). A member of the child protective agencies as defined in Penal Code Section 11165.9; A social worker or investigator employed by the Fresno County Department of Health and Human Services or Child Protective Services; A representative of the State Department of Social Services; An employee, member of the legal staff, or a peace officer employed by the State Department of Social Services, to carry out duties pursuant to Family Code Division 9 and 12, Part 5; Welfare and Institutions Code Section 10850.4 W & I Code Section 827(a)(1)(H), (I), and (J); W & I Code Section 272(a)(1). APPLICATION TO INSPECT AND/OR COPY JUVENILE CASE FILE American LegalNet, Inc. www.FormsWorkFlow.com 2.) 3.) 4.) 5.) 6.) PJV-20 R11-12 MANDATORY APPLICATION TO INSPECT AND/OR COPY JUVENILE CASE FILE COPY REQUEST: I am requesting to inspect and/or copy the following documents: 1.) 2.) 3.) REASON FOR REQUEST: Date filed: Date filed: Date filed: CERTIFICATION TO INSPECT AND COPY: I certify that I am requesting these records for use in my capacity described above. I certify that no portion of those records and information relating to the contents of those records shall be made attachments to any other documents without the prior approval of a Juvenile Delinquency or Dependency Court, unless they are used in connection with and in the course of a criminal investigation or a proceeding brought to declare a person a dependent child or ward of the juvenile court. I certify that no portion of those records and no information relating to the cont ents of those records shall be disseminated by me to any persons or agencies, other than those persons or agencies authorized to receive documents pursuant to Welfare and Institutions Code Section 827. I understand that I am not entitled to inspect and/ or copy the following: court exhibits, court reporters' notes that have not been transcribed, and records which are privileged or confidential pursuant to any other state law, federal law or regulation. I understand that to obtain copies of records which are privileged or confidential pursuant to any other state law, federal law or regulation, I must file a JV-570 Request for Disclosure of Juvenile Case File which specifically identifies the documents by title and date. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (PRINT NAME) (SIGNATURE) DECLARATION AND STATUTORY BASIS FOR APPLICATION TO INSPECT JUVENILE CASE FILE: I, , do hereby declare that I qualify to inspect the documents pursuant to Welfare and Institutions Code Section 827(a)(1) because I am: 7.) 8.) 9.) A person, agency, or multidisciplinary team providing treatment or supervision of the child/minor. W & I Code Section 827(a)(1)(K) A Court-Appointed Special Advocate (CASA). W & I Code Section 827(a)(1)(A); W & I Code Section 103(h). A superintendent or designee of the school district where the child/minor is enrolled or attending school; A staff member for the Board of Prison terms. W & I Code Section 827(a)(1)(G); W & I Code Section 829. APPLICATION TO INSPECT AND/OR COPY JUVENILE CASE FILE American LegalNet, Inc. www.FormsWorkFlow.com PJV-20 R11-12 MANDATORY 10.) A designee of the Fresno Division of the Department of Child Support Services purpose of establishing paternity and establishing and enforcing child support orders; A juvenile justice commission member established under W & I Code Section 225; A probate Court investigator actively participating in a guardianship case and acting within the scope of his/her duties in that case; A member of the Family Court Services staff assigned to a case involving the minor; A child custody evaluator appointed by the Family Law court to conduct child custody evaluation, investigation, or assessment pursuant to Family Code Section 3111 or 3118. W & I Code Section 827(a)(1)(A)(L)(M)(N) & (O). CERTIFICATION TO INSPECT: I certify that I am requesting