LASC JUV 010 Rev. 03/19 DECLARATION IN SUPPORT OF ACCESS Code(s) Welfare and Institutions For Mandatory Use TO JUVENILE RECORDS Code 247247 827 and 362.5 California Rules of Court, rule 5.552 Local Rule 7.2 NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: ATTORNEY FOR (Name): Reserved for Clerk222s File Stamp SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURTHOUSE ADDRESS: PETITIONER: CHILD222S NAME: DOB: DECLARATION IN SUPPORT OF ACCESS TO JUVENILE RECORDS (WIC 247827, WIC 247786(g)(1)(J): CRC Rule 5.552; Local Rule 7.2) CASE NUMBER: Dependency Delinquency A. I am one of the entitled parties or agencies listed under Welfare & Institutions Code (WIC) 247827, WIC 247786(g)(1)(J) California Rules of Court (CRC), rule 5.552, and Los Angeles Superior Court (LASC) Local Rules (LR), rule 7.2 (Check 1 box only): 1. Court Personnel 2. Subject Child/Non-Minor Dependent 3. Attorney for subject child or his or her agent with proper proof of affiliation (including appellate attorney) [continue to Section B below] 4. Subject child222s parent/legal guardian who still has parental rights 5. The attorney for subject child222s parent/legal guardian who still has parental rights, or his or her agent with proper proof of affiliation (including appellate attorney) [continue to Section B below] 6. The County Counsel, City Attorney, or any other attorney representing the petitioning agency in a dependency action, or his or her agent with proper proof of affiliation [continue to Section B below] 7. Attorney authorized to prosecute adult criminal or juvenile matters under California state law (district attorney, city attorney, city prosecutor), or his or her agent with proper proof of affiliation [continue to Section B below] 8. Judge, referee, hearing officer, probation officer, or law enforcement officer actively participating in adult criminal or juvenile proceedings involving the minor a. Criminal case number: b. Juvenile case number: 9. State Department of Social Services staff for the purposes delineated in WIC section 827(a)(1)(I), CRC 5.552(b)(1)(J), LR 7.2(a)(2)(h) 10. State Department of Social Services staff for purposes delineated in WIC section 827(a)(1)(J), LR 7.2(a)(2)(i) 11. Member of child protective agencies per Penal Code section 11165.9 (police, sheriff, county probation, county child welfare) 12. Superintendent or designee of school district where child attends or is enrolled a. School District: 13. Member of child222s multi-disciplinary team as provided in WIC section 830, 830.1, and 18951(d) 14. Person or agency currently providing supervision or treatment of child (physician, surgeon, other health care providers, psychotherapist, sexual assault or domestic violence counselor, group home or foster family agency social worker/case managers, regional center consumer service coordinator) a. Title & relationship to child: 15. Family law judicial officer, or clerk acting on behalf of judicial officers a. Family law case number: 16. Family law mediator or court appointed evaluator actively participating in a family law case involving the subject minor (including person performing investigation or assessment) a. Family law case number: 17. Court-appointed counsel for minor in family law case under Family Code section 3150. Counsel for the minor on related matters is required to provide a copy of the court order appointing him/her as minor222s counsel. a. Family law case number: 18. Court-appointed probate guardianship investigator a. Probate case number: American LegalNet, Inc. www.FormsWorkFlow.com LASC JUV 010 Rev. 03/19 DECLARATION IN SUPPORT OF ACCESS Code(s) Welfare and Institutions For Mandatory Use TO JUVENILE RECORDS Code 247247 827 and 362.5 California Rules of Court, rule 5.552 Local Rule 7.2 19. Local child support agency for establishing paternity and establishing or enforcing child support orders a. Family law case number: 20. Juvenile Justice Commission as established under WIC section 225 21. Person from an Indian tribe, reservation, or tribal court serving in a similar capacity as those listed in Section A, numbers 1, 3, 5, 6, 11, 13, 15, 16, 17, or 18 a. If so, what tribe? b. Please specify your role: 22. Department of Justice for the purpose of determining if the person is suitable to purchase, own or possess a firearm consistent with Section 29820 of the Penal Code, and WIC section 786(g)(1)(J). 23. Probation officer, for the purpose of preparing a report pursuant to Section 1178 on behalf of a person who was in the custody of the Department of Corrections and Rehabilitation, Division of Juvenile Justice and has petitioned the Board of Juvenile Hearings for an honorable discharge. 24. Other (including pursuant to court order; please attach copy of order) B. Attorney C. What type of records are you requesting to access? Please explain below. Dependency Delinquency DCFS Probation D. Why are you requesting the records? For personal use Other reasons (please specify): Will you share the records with anyone else? If so, with whom? (Please provide name and title) If you are entitled and wish to access records from the Department of Children and Family Services (DCFS), please submit this form to DCFS Records Unit/Office of County Counsel 226 address: 201 Centre Plaza Dr. Ste. 1, Monterey Park, CA 91754 226 phone number: (323) 526-6100 226 email: Dependencyrecords@counsel.lacounty.gov. If you are entitled and wish to access records from the Probation Department, please contact the Custodian of Records at (562) 940-2876, or send an email to civillitigationoffice@probation.lacounty.gov. WARNING: Any records, reports, or information obtained from the juvenile record(s) shall not be further released or disseminated to persons or agencies not otherwise entitled to access to juvenile records pursuant to WIC section 827, CRC 5.552, and LR 7.2 (i.e. agencies/individuals listed above). Further, juvenile records shall not be attached to any documents without prior approval of the Juvenile Court Presiding Judge, unless they are used in connection with a criminal investigation or juvenile court proceeding to declare a minor a dependent or ward of the Court. I declare under penalty of perjury that the foregoing is true and correct and that I am aware of the above warning regarding dissemination of juvenile records. Date: Signature: SHORT TITLE: CASE NUMBER: Name: State Bar #: Case No: Court (criminal, juvenile, etc.) Client Name: Client222s relationship to subject of juvenile records: Clear American LegalNet, Inc. www.FormsWorkFlow.com