Petitioner's Name: Address: Telephone: Fax No.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES JUVENILE DIVISION Office of the Presiding Judge 201 Centre Plaza Drive, Suite 3 Monterey Park, CA 91754-2158 CHILD'S NAME: DATE OF BIRTH: MOTHER'S NAME: REQUEST FOR INTERVIEWING, PHOTOGRAPHING, VIDEOTAPING, OR VOICE RECORDING OF DEPENDENT OR DELINQUENT CHILDREN (WIC §827) Case Number: 1. Petitioner alleges the child whom he or she wishes to contact has been found to be within the jurisdiction of the Juvenile Court pursuant to: Welfare & Institutions Code section 300 Welfare & Institutions Code section 601 Welfare & Institutions Code section 602 Unknown 2. Petitioner requests contact with said child for purposes of: Interviewing Photographing Videotaping Voice recording (Specify whether Petitioner requests permission to reveal or show the identity or name of the child and reason why.) 3. Petitioner requests contact with said child for purposes of: Newspaper article Television program Radio program Internet posting Other: (Describe in detail the reason for the request; attach additional pages if necessary.) ___________________________________________________________________________________________________________________________________ REQUEST FOR INTERVIEWING, PHOTOGRAPHING, VIDEOTAPING, OR VOICE RECORDING OF DEPENDENT OR DELINQUENT CHILDREN American LegalNet, Inc. www.FormsWorkFlow.com 4. Petitioner provided notice of the request to the following parties: Child Child's parent/guardian Child's attorney Parent(s)' attorney(s) County Counsel DCFS District Attorney Probation Other: Date served: Date served: Date served: Date served: Date served: Date served: Date served: Date served: Date served: personal service/fax/email; US mail personal service/fax/email; US mail personal service/fax/email; US mail personal service/fax/email; US mail personal service/fax/email; US mail personal service/fax/email; US mail personal service/fax/email; US mail personal service/fax/email; US mail personal service/fax/email; US mail Petitioner asserts that the following facts constitute good cause to shorten the time for the filing of objections to the request (Note: objections are due 15 days if request is served by personal service/facsimile/email and 20 days if served by US mail, in the absence of good cause): I declare under penalty of perjury under the laws of the State of California that the foregoing and all attachments are true and correct. Date: Type or Print Name Signature of Petitioner ORDER 1. Request Granted Additional Orders: 2. Request Denied Reason for Denial: 3. Set Hearing on request. Clerk to provide notice to parties and petitioner. Date: Judicial Officer ___________________________________________________________________________________________________________________________________ REQUEST FOR INTERVIEWING, PHOTOGRAPHING, VIDEOTAPING, OR VOICE RECORDING OF DEPENDENT OR DELINQUENT CHILDREN American LegalNet, Inc. www.FormsWorkFlow.com