1.Petitioner alleges the child whom he or she wishes to contact has been found to be within the jurisdiction of theJuvenile Court pursuant to:Welfare & Institutions Code section 300Welfare & Institutions Code section 601Welfare & Institutions Code section 602Unknown2.Petitioner requests contact with said child for purposes of:InterviewingPhotographingVideotapingVoice 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 articleTelevision programRadio programInternet postingOther:(Describe in detail the reason for the request; attach additional pages if necessary.) Petitioner222s 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 CHILD222S NAME: DATE OF BIRTH: MOTHER222S NAME: REQUEST FOR INTERVIEWING, PHOTOGRAPHING, VIDEOTAPING, OR VOICE RECORDING OF DEPENDENT OR DELINQUENT CHILDREN (WIC 247827) Case Number: 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:ChildDateserved:personal service/fax/email; US mailChild222s parent/guardianDate served: personal service/fax/email; US mailChild222s attorneyDate served: personal service/fax/email; US mailParent(s)222 attorney(s)Date served:personal service/fax/email; US mailCounty CounselDate served: personal service/fax/email; US mailDCFSDateserved:personal service/fax/email; US mailDistrict AttorneyDate served: personal service/fax/email; US mailProbationDate served:personal service/fax/email; US mailOther:Dateserved:personal service/fax/email; US mailPetitioner asserts that the following facts constitute good cause to shorten the time for the filing of objectionsto the request (Note: objections are due 15 days if request is served by personal service/facsimile/email and20 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 GrantedAdditional Orders:2. Request DeniedReason 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