MJV-150 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number and address) TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO ADDRESS: CITY AND ZIP CODE: BRANCH NAME: In the matter of: CASE NUMBER: Hearing Date: Child(ren) Time: Department: REQUEST FOR TELEPHONE APPEARANCE (Juvenile Dependency) 1. I, (name): parent other (specify): attorney for (name): I ask the court to allow am the in this case. to appear telephonically at the above hearing. 2. 3. I have given all parties 48 hours notice by: Placing the phrase "Telephone Appearance" below the title of the moving, opposing, or reply papers; or Serving all other parties with this request I understand that upon the granting of my Request for Telephone Appearance - (Juvenile Dependency) I must contact CourtCall, LLC, to arrange teleconferencing services at my own expense. The Court has contracted with CourtCall, LLC to provide teleconferencing services. Information as to the forms and fees may be obtained directly from CourtCall, LLC at 1888-88-COURT I request the Court waive the requirement to use CourtCall, LLC, and any fees associated with my request to appear telephonically due to the following: receives public benefits The gross monthly household income (before deductions for taxes) of is less than the amount listed below: Family Size 5 6 Family Income $2,907.30 $3,330.21 4. 5. Family Size Family Income Family Size Family Income 1 $1,215.63 3 $2,061.46 2 $1,638.55 4 $2,484.38 ** If more than 6 people at home, add $389.59 for each extra person. waiver of the telephonic appearance fees. is a minor Based on information and belief, appearance fees. does not have enough income to pay for his/her household's basic needs and telephonic is a Tribal Representative and through County Counsel has requested a I declare under penalty of perjury under the laws of California that the information I have provided on this form and all attachments is true and correct except as to matters stated on information and belief and as to those matters I believe them to be true. Date: Print your name here Sign here MJV-150 (rev 010117) American LegalNet, Inc. www.FormsWorkFlow.com ADVISEMENT REGARDING TELEPHONE APPEARANCE 1. I know that I can personally appear at this hearing, and I give up that right. I agree to be duly sworn upon request by the court clerk, holding up my right hand and agreeing under penalty of perjury under the laws of the State of California to tell the truth and nothing but the truth. 2. I understand that if I do not make the proper arrangements for a telephone appearance as set out in local rules or in directions provided by the court, the matter may proceed without my personal or telephone appearance and the court may decide my case based on the documents filed and any testimony given for this hearing. 3. I understand that the court may decide at any time to require my personal appearance and continue my hearing. I have read the Advisement Regarding Telephone Appearance section of this form and I understand that the terms apply to me. Date: Signed: MJV-150 (rev 010117) American LegalNet, Inc. www.FormsWorkFlow.com MJV-150 (rev 010117) American LegalNet, Inc. www.FormsWorkFlow.com