FOR COURT USE ONLY Application submitted by: (Name and Address) Name: Street Address City, State: Telephone Number: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO Street Address: 9605 Kiefer Blvd. 3341 Power Inn Road City and Zip Code: Sacramento, CA 95827 Sacramento, CA 95826 Branch Name: SITTING AS THE JUVENILE COURT NAME OF CHILD/MINOR: Date of Birth: DECLARATION: RELEASE OF JUVENILE RECORDS WITHOUT COURT ORDER (Welf. & Inst. § 827, Rule of Court 1423) CASE NUMBER: I, ________________________________________________________________, do hereby declare: 1. That I am a person described in Welfare and Institutions Code section 827(a)(1)(A)-(N) or 829, to wit: General Copying (Standing Order 99-021, § H) □ The child/minor who is/was the subject of the □ □ □ □ □ □ □ □ □ □ juvenile record (whether or not presently over the age of eighteen, but with consent of attorney or guardian ad litem if under age eighteen). A parent or guardian of the child/minor who is/was the subject of the juvenile record. An attorney who presently represents the child/minor who is/was the subject of the juvenile record (whether or not presently over the age of eighteen). (An attorney who presently represents a child in a family law case must provide a certified copy of the court order appointing counsel.) An attorney who presently represents a parent or guardian of the child/minor who is/was the subject of the juvenile record. A deputy district attorney from any county. A city attorney from any city authorized to prosecute criminal or juvenile cases under state law. A Sacramento County Deputy County Counsel. A deputy Probation officer from any county, state or federal district. A social worker or investigator employed by the Sacramento County Department of Health and Human Services. A member of the legal staff or a peace officer employed by the State Department of Social Services. A deputy sheriff or police officer from any county or city. JC\E-004 07/26/06 □ A law enforcement officer, other than a deputy □ □ □ □ □ sheriff or city police officer, who is actively participating in criminal or juvenile proceedings involving the child/minor (whether or not presently over the age of eighteen). A person, agency or multidisciplinary team providing treatment or supervision of the child/minor. Court personnel from any county, including a judge, referee, commissioner or other hearing officer of the adult or juvenile court. A member of the Family Court services staff. A child custody evaluator appointed by the family law court who is actively participating in a family law case. A Probate Court investigator. Limited Copying (Standing Order 99-021, § G) □ A superintendent or designee of the school district □ □ □ □ where the child/minor is enrolled or attending school. A staff member for the Board of Prison Terms. A juvenile justice commissioner appointed pursuant to Welfare and Institutions Code § 225. A designee of the Sacramento division of the Department of Child Support Services A social worker or investigator employed by the Sacramento County Department of Human Assistance or any county welfare department. Declaration: Release of Juvenile Records Without Court Order American LegalNet, Inc. www.FormsWorkflow.com 2. That I am requesting to view and copy juvenile records, as described on the attached page, concerning the above-named child/minor currently in the possession of the: □ Juvenile Court □ Probation Department □ Dept. of Health & Human Services □ Court-Appointed Special Advocates □ Other __________________________________________ 3. That I certify that I am requesting these records for use in my official capacity and that I will not disseminate any portion of the records released to me or information relating to their contents, other than to other persons or agencies described in Standing Order SSC-JV-99-021 or Local Rule 19.03 and that no portion of those records and no information relating to the contents of those records shall be made attachments to any other documents 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 a proceeding brought to declare a person a dependent child or ward of the juvenile court. I declare under penalty of perjury that the above is true and correct. Executed this _________ day of __________________________________ in Sacramento, California. Signature: __________________________________________________ Name (printed): _____________________________________________ Title (printed): ______________________________________________ Address and telephone: _______________________________________ __________________________________________________________ For Office Use Only □ Granted □ Denied Date: _________________ Clerk Processing: _________________________________ JC\E-004 07/26/06 Declaration: Release of Juvenile Records Without Court Order American LegalNet, Inc. www.FormsWorkflow.com