ATTORNEY OR PARTY WITHOUT ATTORNEY(Name, state bar number, and address): TELEPHONE NO.: FOR COURT USE ONLY FAX NO.: ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO JUVENILE COURT 2851 MEADOW LARK DR., SAN DIEGO, CA 92123-2792 325 S. MELROSE DR., VISTA, CA 92081-6634 500 3RD AVE., CHULA VISTA, CA 91910-5649 250 E. MAIN ST., EL CAJON, CA 92020-3941 IN THE MATTER OF A MINOR NOTICE OF APPEAL FROM JUDGMENT OR ORDER (Welfare and Institutions Code sections 300 et seq.) CASE NO.: appeals from the order or judgment of this court entered . (Date of order or judgment) The appeal is from: (check the appropriate item) 1. 2. A judgment made at a disposition hearing declaring a minor to be a dependent child of the juvenile court. An order made at a review hearing or other hearing after a minor has been declared a dependent child, affecting reunification, visitation, or other appealable order. (I am not appealing an order directing that a hearing be held pursuant to Welfare and Institutions Code § 366.26 [such issues must be raised by writ petition]). 3. 4. A judgment terminating parental rights. A judgment establishing a guardianship or another planned permanent living arrangement at a hearing pursuant to Welfare and Institutions Code Section 366.26. Date: OR Signature of Appellant I declare under penalty of perjury under the laws of the State of California that this appeal is authorized by my client. Date: Signature of Trial Counsel MOTION FOR APPOINTMENT OF COUNSEL (To be signed by Appellant whenever possible) MOTION BY CLIENT: I request the Court of Appeal, Fourth Appellate District, to appoint an attorney to represent me in this appeal. I do not have sufficient means to hire an attorney. My spouse (if applicable) and I have the following combined income and property: Take-home pay from job (monthly) $ Other income (monthly) $ I own a home. Money in bank at this time $ I do not own a home. My trial attorney was: A public defender or court-appointed attorney. Check one: An attorney paid by myself. Other: Date: Signature of Appellant OR MOTION BY TRIAL COUNSEL: I am informed and believe and on that basis allege that the appellant is indigent. I request that counsel for the appeal be appointed. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Signature of Trial Counsel SDSC JUV-3(Rev. 9-05) NOTICE OF APPEAL FROM JUDGMENT OR ORDER American LegalNet, Inc. www.USCourtForms.com