SUPERIOR COURT FOR THE STATE OF CALIFORNIA COUNTY OF MENDOCINO APPLICATION AND ORDER REGARDING REMOVAL OF A MINOR FROM A JUVENILE INSTITUTION BY LAW ENFORCEMENT PERSONNEL PETITION NO. ________________ NAME OF MINOR: LOCATION OF MINOR: D.O.B. ___________________ NAME OF PARENT/GUARDIAN: ADDRESS: TELEPHONE NUMBER: ATTORNEY FOR MINOR: ADDRESS: TELEPHONE NUMBER: PROBATION OFFICER: OFFICER/AGENCY REQUESTING REMOVAL OF MINOR: NATURE OF REQUEST (Why is minor's removal necessary) ____________________________ Signature of Officer Making Request I approve: (Signature of Parent/Guardian) I approve: (Signature of Minor) I approve: (Signature of Attorney for Minor) I approve: (Signature of Probation Officer) American LegalNet, Inc. www.FormsWorkflow.com The application is granted/denied. The following conditions must be followed: Dated: ________________________ Judge of the Superior Court Right to Counsel: If the minor is not represented by counsel, the probation officer shall advise him/her of the right to counsel at no cost. If an unrepresented minor declines to consult with an attorney, or be represented, the probation officer or social worker shall note that fact on the application. American LegalNet, Inc. www.FormsWorkflow.com