Application submitted by: (Name and Address) Name: _______________________________ Street Address: ________________________ City, State: ___________________________ TELEPHONE NO: _____________________ FOR COURT USE ONLY 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 Child's Name: COMPLAINT REGARDING PERFORMANCE OF COURT APPOINTED ATTORNEY Name of applicant: Relationship to the child(ren): Attorney's Name: CASE NUMBER: I am requesting the following: (must be typewritten or printed legibly) Provide the specific reasons for my complaint: (if you are requesting new counsel, do not explain in writing; instead wait to provide the information in court) Attach separate page if needed. Dated: ________________________ _________________________________ Signature Any complaint must be submitted on this form or at least have this form as a cover page to the application. The application must be filed at the Juvenile Dependency Reception Counter, William R. Ridgeway Family Relations Court, 3341 Power Inn Road, Sacramento, California. Case Name: attorney Court No: JC\E-003 (08.07) Complaint regarding performance of Court appointed Page 1 of 1 Date: American LegalNet, Inc. www.FormsWorkFlow.com