FOR DEPARTMENT OR 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: INSPECTION AND GENERAL RELEASE OF JUVENILE RECORDS WITHOUT FURTHER COURT ORDER – JUVENILE COURT CASE FILED and CASE NOT FILED (Welfare & Institutions Code § 827, California Rules of Court, rule 5.552, CASE NUMBER: Standing Order SSC-JV-99-021, Attachment A, section II.) I, ________________________________________________________________, do hereby declare that: 1. I am a person described in Welfare and Institutions Code section 827(a)(1)(A)-(F), (H) or (I), to wit: 1. 2. 3. 4. 5. 6. 7. 8. 9. Court personnel from any county, including a judge, referee, commissioner or other hearing officer of the adult or juvenile court. [WIC § 827(a)(1)(A) & (E)] A member of the Family Court services staff. [WIC § 827(a)(1)(A) & (L)] A Probate Court investigator. [WIC § 827(a)(1)(A) & (M)] A deputy district attorney from any county. [WIC § 827(a)(1)(B)] A city attorney from any city authorized to prosecute criminal or juvenile cases under state law. [WIC § 827(a)(1)(B)] 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). [WIC § 827(a)(1)(C)] A parent or guardian of the child/minor who is/was the subject of the juvenile record. [WIC § 827(a)(1)(D)] A deputy Probation Officer from any county, state or federal district. [WIC § 827(a)(1)(E)] A social worker or investigator employed by the Sacramento County Department of Health and Human Services. [WIC §§ 272(a)(1) & 827(a)(1)(E)] JC\E-014 Eff. 07/16/09 10. A Sacramento County Deputy County Counsel. [WIC § 827(a)(1)(E) & (F)] 11. 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.) [WIC § 827(a)(1)(E) & (L)] 12. An attorney who presently represents a parent or guardian of the child/minor who is/was the subject of the juvenile record. [WIC § 827(a)(1)(E)] 13. 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]. [WIC § 827(a)(1)(E)] 14. A deputy sheriff or police officer from any county or city. [WIC § 827(a)(1)(H) & PC § 11165.9] 15. An employee, member of the legal staff or a peace officer employed by the State Department of Social Services. [WIC § 827(a)(1)(I) & (J)] 16. Court Appointed Special Advocate (CASA) [§ 827(a)(1)(A) and (C); § 103(h)] Declaration: Inspection and General Release of Juvenile Records Without Further Court Order Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 2. Pursuant to Standing Order SSC-JV-99-021, I am requesting to view and/or copy juvenile records concerning the above-named Child/Minor currently in the possession of the: Juvenile Court Dept. of Health & Human Services Probation Department Court-Appointed Special Advocates 3. Inspection and Copying - Pursuant to Standing Order SSC-JV-99-021, sections C.2. and E., I am allowed to view and copy the following records: a. The petition and all other documents filed in a Juvenile Court delinquency or dependency case; b. Reports to the Juvenile Court in a delinquency or dependency case prepared by probation officers or social workers of the Child Protective Services Division of the Department of Health and Human Services , and Court-Appointed Special Advocates; c. Documents not filed with the Juvenile Court, but made available to, or created by, probation officers, social workers of the Child Protective Services Division of the Department of Health and Human Services, or Court-Appointed Special Advocates (CASA) in preparation of reports as part of an investigation to determine whether a child/minor comes within the jurisdiction of the Juvenile Court or for filing a report with the Juvenile Court for a delinquency or dependency case; d. Transcripts that have previously been prepared, records, or reports relating to matters prepared or released by the Juvenile Court, Probation Department, or the Child Protective Services Division of the Department of Health and Human Services, for a Juvenile Court delinquency or dependency case; e. Documents admitted into evidence at Juvenile Court hearings for a delinquency or dependency case. f. Documents in the possession of the Child Protective Services Division of the Department of Health and Human Services, developed or retained as part of an investigation to determine whether a child comes within the jurisdiction of the Juvenile Court, concerning which no jurisdictional petition was filed in the Juvenile Court pursuant to Welfare and Institutions Code section 300 regarding that child. g. Documents in the possession of the Probation Department, developed or retained as part of an investigation to determine whether a person comes within the jurisdiction of the Juvenile Court, concerning which no jurisdictional petition was filed in the Juvenile Court pursuant to Welfare and Institutions Code sections 601 or 602 regarding that minor. 4. Items Not Subject to Disclosure: I understand that Standing Order SSC-JV-99-021 does not provide for disclosure of the following: a. Court exhibits; b. Court reporters’ notes that have not been transcribed; and c. Records which are privileged or confidential pursuant to any other state law, federal law or regulation. To obtain copies of items a.-c., I must file a JV-570 Petition for Disclosure of Juvenile Court Records which specifically identifies the items by title and date and obtain a further court order. 5. I certify I am requesting these records for use in my capacity described above and 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 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. JC\E-014 Eff. 07/16/09 Declaration: Inspection and General Release of Juvenile Records Without Further Court Order Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 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 Date: _________________ Granted Denied Clerk Processing: _________________________________ JC\E-014 Eff. 07/16/09 Declaration: Inspection and General Release of Juvenile Records Without Further Court Order Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com