RECORD SEALING LIST OF AGENCIES ATTACHMENT PAGE Minor: DOB: Date Petition Filed: If there are multiple petitions ordered sealed, a separate Records Sealing List of Agencies form should be completed for each petition. Court Case Number: Date of Order: Sealing is Ordered pursuant to: 786 WIC 793(c) WIC 781 WIC Date of Arrest: Crime Report /Incident Number: TO THE CUSTODIAN OF RECORDS: The Court has ordered each agency listed below to seal the records in its custody as directed by the order. If sealing is ordered under WIC �� 781 or 786, the agencies listed below shall advise the Court of its compliance with the sealing order. A blank Acknowledgment of Juvenile Records Sealed form is provided for your convenience. Please return the completed acknowledgement to the Court. Department of Justice P.O. Box 903417 Sacramento, CA 94203-4170 Riverside Superior Court � Juvenile Division Riverside County Probation Department Riverside County District Attorney Law Enforcement Agency Law Enforcement Agency Department of Motor Vehicles P.O. Box 942890 Sacramento, CA 94290-0001 Page 1 of 1 Approved for Optional Use Riverside Superior Court RI-JV019 [Rev. 01/01/16] RECORD SEALING LIST OF AGENCIES ATTACHMENT PAGE riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com