Superior Court of California, County of Humboldt Appendix 8.28 Local Form CCV-8.3 SUPERIOR COURT OF CALIFORNIA, COUNTY OF HUMBOLDT In the Matter of: Petitioner: Respondent: ______ Case No: ORDER APPOINTING COURT INVESTIGATOR AND/OR CHILD CUSTODY RECOMMENDING COUNSELOR AND RELEASING INFORMATION 1. Having found good cause, the Court appoints Paul Landrum, Joseph Hale and/or ________________________________________________________ as Court Appointed Investigator(s) and/or Child Custody Recommending Counselor(s) in regard to the issues set forth in Family Code §§3110, et seq. 2. The court finds that the following records may have direct bearing on the issues of child custody, visitation, safety, health, welfare and the best interests of the child(ren) of the parties in this action. Copies of all documents contained in the file shall be provided to the Court's Court Appointed Investigator(s) and/or Child Custody Recommending Counselor(s) in order to assure that the court is able to perform the duties set forth in the law relative to the custody, visitation, safety, welfare and stability of the child(ren): a. Criminal history information including arrest records, probation reports, parole records and records relating to criminal acts that may show histories, or characteristics that interfere with the ability to offer safety and stability to children. b. Law enforcement records, such as contacts or field interrogations, not resulting in criminal history, showing domestic violence or incapacity to parent effectively, including issues related to drugs or mental health problems. c. Child Welfare Service records dealing with abuse or neglect by one or both parents and records regarding foster home or group home placement or placements with relatives. d. Alternative Response Team (ART) records. e. School records of each child involved in the litigation. f. Medical records of both parents and each child involved in the litigation and pharmacy records of the family. g. Mental health records of both parents and each child involved in the litigation. These may include drug or alcohol treatment records and records of any treatment in rehabilitation facilities or halfway houses. h. Mediator records. i. Military Service records of the parents. 3. Should counsel be appointed for the minor child(ren) of the parties, the above-noted records shall be released to Minor's Counsel upon written request to the Court Appointed Investigator(s) and/or Child Custody Recommending Counselor(s). 140 American LegalNet, Inc. www.FormsWorkFlow.com Superior Court of California, County of Humboldt CONSENTS I, __________________________________, am the father in this case. I have read this order. I understand it. I consent to its terms and authorize access to all the requested records. DATE: __________________ ____________________________________ Father I, __________________________________, am the mother in this case. I have read this order. I understand it. I consent to its terms and authorize access to all the requested records. DATE: __________________ ____________________________________ Mother I, __________________________________, am the new spouse/an adult living with one of the parties in this case. I have read this order. I understand it. I consent to its terms and authorize access to all the requested records. DATE: __________________ ____________________________________ Other Adult I, __________________________________, am the new spouse/an adult living with one of the parties. I have read this order. I understand it. I consent to its terms and authorize access to all the requested records. DATE: __________________ ____________________________________ Other Adult ORDER Based on the applicable law and on the above consents, the Court appoints the Court Appointed Investigator(s) and/or Child Custody Recommending Counselor(s) as outlined in this order. Copies of the documents specified in this order shall be delivered to the custody of the Court Appointed Investigator(s) and/or Child Custody Recommending Counselor(s), who shall treat them as confidential records of the Court. DATE: ___________________ ____________________________________ Judge/Commissioner of the Superior Court ATTACHMENT TO APPOINTMENT ORDER: NAMES, ADDRESSES, AND DATES OF BIRTH OF PERSONS SUBJECT TO THE APPOINTMENT ORDER. FATHER: Name: ______________________________ Date of Birth: _____________________ 141 American LegalNet, Inc. www.FormsWorkFlow.com Superior Court of California, County of Humboldt Aliases/Previous names: __________________________________________________ Address: ______________________________________________________________ Telephone (Home): _______________________ (Work) ________________________ (Cell): ________________________ MOTHER: Name: ______________________________ Date of Birth: _____________________ Aliases/Previous names: __________________________________________________ Address: ______________________________________________________________ Telephone (Home): _______________________ (Work) ________________________ (Cell): ________________________ MINORS: 1. 2. 3. 4. 5. 6. Name ______________________________ Date of Birth: ___________________ Name ______________________________ Date of Birth: ___________________ Name ______________________________ Date of Birth: ___________________ Name ______________________________ Date of Birth: ___________________ Name ______________________________ Date of Birth: ___________________ Name ______________________________ Date of Birth: ___________________ OTHER (New Spouse or Other Adult Living in Home) Name: _________________________________ Date of Birth: ___________________ Aliases/Previous Names: _________________________________________________ Telephone (Home): ____________________ (Work) ________________________ (Cell): ____________________ Name: _________________________________ Date of Birth: ___________________ Aliases/Previous Names: _________________________________________________ Telephone (Home): ____________________ (Work) ________________________ (Cell): ____________________ Adopted for Mandatory Use Order Apptg CI & CCR Counselor & Rel Info Form CCV-8.3, Eff. 07/01/13 142 American LegalNet, Inc. www.FormsWorkFlow.com