ATTORNEY OR PARTY WITHOUT AN ATTORNEY (Name, State Bar number and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: 3341 Power Inn Road, William R. Ridgeway Family Relations Courthouse Sacramento, CA 95826 Sitting as the Juvenile Court CASE NUMBER(S): CHILD(REN)'S NAMES: NOTICE OF REASSIGNMENT OF COURT APPOINTED ATTORNEY (Without Court Order) Next Court Date: Date: Time: Dept.: THE COURT AND ALL PARTIES ARE NOTIFIED THAT the following legal representative declares a conflict in representing the below named party and makes this reassignment of attorney: 1. Name of former legal representative: with agency: 2. CLCSac-1 CLCSac-2 CLCSac Conflict PAS DAS SCJD Name of new legal representative: with agency: Address: CLCSac-1 Street address: City and Zip Code: CLCSac-2 CLCSac Conflict PAS Telephone No.: DAS SCJD 3. The party receiving new legal representation is: Other (specify): The matter is currently pending a (type of hearing) The new legal representative was notified on (date) Child Mother Father 4. 5. 6. hearing on (date) at (time) . in Department . of the assignment of counsel. Discovery to be provided to the new legal representative on (date) Signature of Attorney I declare under penalty of perjury under the laws of the State of California that the information in this form is true and correct to my knowledge. Signature of Attorney Date Type Name JC\E-362 Effective 5/20/2013 NOTICE OF REASSIGNMENT OF COURT APPOINTED ATTORNEY (Without Court Order) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com