JC-E 667 Declaration submitted by: Name: Office/Agency/Court: Street Address: City, State: Telephone Number: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO Sitting as the Juvenile Court Street Address: City and Zip Code: Name of Minor: Date of Birth: 9605 Kiefer Blvd. Sacramento, CA 95827 3341 Power Inn Road Sacramento, CA 95826 FOR COURT USE ONLY DECLARATION FOR ACCESS TO JUVENILE CASE FILE IN POSSESSION OF JUVENILE COURT (Welfare & Institutions Code § 827, California Rules of Court, rule 5.552) CASE NUMBER: I, ________________________________________________________________, do hereby declare that I am a person described in Welfare and Institutions Code section 827(a)(1)(A)-(O), to wit: A. Persons entitled to inspect and receive copies of juvenile case files 1. 2. Juvenile court personnel. [WIC § 827(a)(1)(A)] A district attorney, city attorney, or city prosecutor authorized to prosecute criminal or juvenile cases under state law. [WIC § 827(a)(1)(B)] The minor who is the subject of the juvenile proceeding. [WIC § 827(a)(1)(C)] A parent or guardian of the minor. [WIC § 827(a)(1)(D)] An attorney for the minor who is actively participating in criminal or juvenile proceedings involving the minor. [WIC § 827(a)(1)(E)] An attorney for the parent or guardian of the minor who is actively participating in criminal or juvenile proceedings involving the minor. [WIC § 827(a)(1)(E)] An attorney representing the petitioning agency in a dependency action. [WIC § 827(a)(1)(F)] A judge, referee, or hearing officer who is actively participating in criminal or juvenile proceedings involving the minor. [WIC § 827(a)(1)(E)] A probation officer actively participating in criminal or juvenile proceedings involving the minor. [WIC § 827(a)(1)(E)] 10. A social worker or investigator employed by a child protective agency. [WIC §§ 272(a)(1) & 827(a)(1)(H)] A law enforcement officer, other than a deputy sheriff or city police officer, who is actively participating in criminal or juvenile proceedings involving the minor. [WIC § 827(a)(1)(E)] A deputy sheriff or city police officer. [WIC § 827(a)(1)(H) & PC § 11165.9] A probation officer who receives mandated reports of suspected child abuse or neglect pursuant to county designation. [WIC § 827(a)(1)(H) & PC § 11165.9] A State Department of Social Services employee engaged in the oversight and monitoring of county child welfare agencies, children in foster care or receiving foster care assistance, and/or out-of-state placements. [WIC § 827(a)(1)(I)] Court-Appointed Special Advocate (CASA). [WIC §§ 827(a)(1)(A) & 103(i)] A person from an Indian tribe, reservation, or tribal court serving in a similar capacity as those described in section A, numbers 1 or 5-13, in a case involving a minor who is a member of, or who is eligible for membership in, that tribe. [WIC § 827(f)] 11. 3. 4. 5. 12. 13. 6. 14. 7. 8. 15. 16. 9. JC-E 667 Mandatory Revised: 01/3/17 DECLARATION FOR ACCESS TO JUVENILE CASE FILE IN POSSESSION OF JUVENILE COURT Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com JC-E 667 Your Name: ________________________________ Case Number: ___________________ B. Persons entitled to inspect juvenile case files (no copies) 1. A superintendent or designee of the school district where the minor is enrolled or attending school. [WIC § 827(a)(1)(G)] 2. A State Department of Social Services legal staff or special investigator peace officer engaged in the inspection, licensing and investigation of community care facilities. [WIC § 827(a)(1)(J)] 3. A person, agency, or member of a multidisciplinary team providing treatment or supervision of the minor. [WIC § 827(a)(1)(K)] 4. A judge, commissioner, or hearing officer assigned to a family law case involving the custody and/or visitation of the minor. [WIC § 827(a)(1)(L)) 5. A family court mediator actively participating in a family law case involving the minor. [WIC § 827(a)(1)(L)] 6. A child custody evaluator actively participating in a family law case involving the minor. [WIC § 827(a)(1)(L)] 7. An attorney appointed for the minor in a family law case. [WIC § 827(a)(1)(L)] 8. A statutorily authorized or court-appointed probate investigator who is actively participating in an active guardianship case involving the minor. [WIC § 827(a)(1)(M)] 9. A statutorily authorized or court-appointed investigator conducting an investigation pursuant to Family Code section 7663, 7851, or 9001 in an active case. [WIC § 827(a)(1)(M)] 10. A local child support agency employee engaged in establishing paternity and/or establishing and enforcing child support orders. [WIC § 827(a)(1)(N)] 11. A juvenile justice commissioner appointed pursuant to Welfare and Institutions Code § 225. [WIC § 827(a)(1)(O)] 12. A person from an Indian tribe, reservation, or tribal court serving in a similar capacity as those described in section B, numbers 3-9, in a case involving a minor who is a member of, or who is eligible for membership in, that tribe. [WIC § 827(f)] I further declare: C. I am requesting to view and/or receive copies of the juvenile case file concerning the above-named minor for use in my capacity described above, and will not share any portion of the records released to me or information relating to their contents, other than as provided by law. ____[Initial] D. I will not attach any portion of the juvenile case file or any information relating to the contents of the juvenile case file to any other document without the prior approval of the Presiding Judge of the Juvenile Court, unless they are used in connection with and in the course of a criminal investigation or prosecution, a proceeding to declare a person a dependent child or ward of the Juvenile Court, or a proceeding described in Welfare and Institutions Code section 827(a)(1)(I) by the State Department of Social Services. _____[Initial] E. Designation of Authorized Agent: I authorize ________________________________ as my agent to view and/or receive copies of the requested records. I declare under penalty of perjury that the above is true and correct. Executed this Signature day of , 20 in Sacramento, California Print Title If applicable, indicate the following: State Bar No. (Attorneys): Badge No. (Law Enforcement): Agency Case No.: Related (non-juvenile) Case No.: For Court Use Only GRANTED DENIED Date: __________ By Clerk: __________________________ JC-E 667 Mandatory Revised: 01/3/17 DECLARATION FOR ACCESS TO JUVENILE CASE FILE IN POSSESSION OF JUVENILE COURT