SUPERIOR COURT, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA JUVENILE COURT INDIO 46-200 Oasis St., Indio, CA 92201 RIVERSIDE 9991 County Farm Road, Riverside, CA 92503 ATTORNEY OR UNREPRESENTED PARTY (Name and Address) TELEPHONE NO.: FOR COURT USE ONLY BAR NO.: ATTORNEY FOR: In re: , a minor CASE NUMBER: NOTICE OF APPEAL (Rule 39, California Rules of Court) 395 W&I Code 800 W&I Code TO: The Clerk of the above-entitled court: NOTICE IS HEREBY GIVEN that the minor parent(s) guardian hereby appeals from the judgment (final disposition) entered in this matter on from the order entered in this matter from that particular part of the ; to wit: judgment Said appeal is based on an entry of order entered in this matter on ; to wit: an admission that the allegations of the petition are true no contest concerning the truth of the allegations and upon grounds occurring after the above-entry which do not challenge the validity thereof, to wit: upon grounds involving a search or seizure, the validity of which was contested pursuant to section 1538.5 of the Penal Code. Petition for Writ of was was not filed with the Court of Appeal. If so, filed on , Court of Appeal number upon grounds indicated in the statement on the reverse side showing reasonable, constitutional, jurisdictional, or other grounds going to the legality of the proceedings for which a certificate of probable cause is requested. Dated: Additional record requested - see reverse. (Signature of Appellant/Attorney) ****************************** REQUEST FOR COUNSEL I, the above-indicated appellant, do hereby declare under the penalty of perjury that I am without funds, am indigent, and unable to hire private counsel to represent me in this appeal. I request that the Court appoint counsel to represent me in this appeal. Executed on , at , California. Attachment: Petition to proceed In Forma Pauperis, if applicable. Juv10 (11/95) NOTICE OF APPEAL (Signature of Appellant) 2002 © American LegalNet, Inc. RI-JV010 STATEMENT FOR CERTIFICATE OF PROBABLE CAUSE (If applicable) (Cross-reference 1237.5 of the Penal Code) Executed on , at , California Additional space being required, see attached sheet(s) (Signature of Appellant) ******************************** ORDER Good cause appearing, the court hereby certifies that probable cause, as above-stated, exists for an appeal herein and this order shall constitute the Court's certificate of probable cause. The court determines that insufficient cause exists and hereby denies the issuance of a certificate of probable cause. Date: JUDGE OF THE JUVENILE COURT 2002 © American LegalNet, Inc.