Application submitted by (Name and Address) Name: Street Address: City, State: Telephone Number: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO Street Address: 3341 Power Inn Road City and Zip Code: Sacramento CA 95826 Branch Name: SITTING AS THE JUVENILE COURT NAME OF CHILD/MINOR: FOR COURT USE ONLY APPLICATION FOR REHEARING AND STATEMENT (W&I CODE, §252) CASE NUMBER: I am an attorney at law representing a parent or minor or the Department of Health and Human Services. I am the minor, parent or guardian and I am not represented by counsel. I request a rehearing from the findings and order of the Referee as indicated below: The proceedings heard by Referee _____________________________________ on __________________________. (Name of Judicial Officer) (Please specify all dates) Below is a statement of the reasons the rehearing is being requested. STATEMENT OF REASONS FOR REHEARING (Must be typewritten) (Attach separate page if needed). DATED: ___________________________ SIGNED: ___________________________________________ Relationship to Minor: _________________________________ Section 252 of the Welfare and Institutions Code provides that a minor or his or her parent or guardian, or in cases brought pursuant to Section 300, the county welfare department may apply to the Juvenile Court for a rehearing. Such application may be directed to all or any specified part of the order or findings, and shall contain a statement of the reasons such hearing is requested. Pursuant to Juvenile Court Standing Order #99-025, any application for rehearing must be submitted on this form or at least have this form as a cover page to the application. The application must be filed in person at the Juvenile Reception Counter, William R. Ridgeway Family Relations Courthouse, 3rd Floor, 3341 Power Inn Road, Sacramento California. Case Name: Case No: JC\E-001 (03.05) Application for Rehearing Dated: American LegalNet, Inc. www.USCourtForms.com