I O., Indio, CA 92 9991 County Farm Rd., Riverside, CA 92503 30755- Auld Rd., Murrieta, CA 92563 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) FOR COURT USE ONLY TELEPHONE NO.: FAX NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): IN THE MATTER OF: CASE NUMBER: Hearing Date: Time: Department: To: District Attorney, County of Riverside, 9991 County Farm Rd., Riverside, CA 92503 Probation Officer, County of Riverside, 9889 County Farm Rd., Riverside, CA 92503 District Attorney, County of Riverside, 46-209 Oasis St., Indio, CA 92201 Probation Officer, County of Riverside, 47-671 Oasis St., Indio, CA 92201 has filed a petition for sealing records of the above-named pursuant to Section 781 of the Welfare and Institutions Code, and the hearing thereon has been set for at a.m., in Dept. of the Courthouse in , California. Dated: . Attachment: By: , Deputy I, , Deputy Clerk, Superior Court of California, County of Riverside, do herby certify that I am not a party to the within action or proceeding; that I served a copy of the NOTICE OF HEARING (781 W&I Code), this date, by depositing the said copy enclosed in a sealed envelope with postage thereon fully prepaid, in the United States post office mailbox at the City of , California, address as follows: District Attorney, County of Riverside, 9991 County Farm Rd., Riverside, CA 92503 Probation Officer, County of Riverside, 9889 County Farm Rd., Riverside, CA 92503 District Attorney, County of Riverside, 46-209 Oasis St., Indio, CA 92201 Probation Officer, County of Riverside, 47-671 Oasis St., Indio, CA 92201 I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: (TYPE OR PRINT NAMEOF ATTORNEY PARTY MAKING DECLARATION) (SIGNATURE) Approved for Optional Use Riverside Superior Court RI-JV013 [Rev. /11] Welfare and Institutions Code 247 781 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com