Superior Court of California, County of San Francisco UNIFIED FAMILY COURT JUVENILE DEPENDENCY Authorization for Funds for Appointment of Private Social Worker IN THE MATTER OF: Case Number: (Defendant/Minor) GOOD CAUSE APPEARING, IT IS HEREBY ORDERED that public funds be provided on application by attorney, _________________________________, for the purpose of retaining a private social worker in the above captioned matter, said funds not exceed $ _______________________. SUMMARY OF SOCIAL WORKER TASKS: Attorney Signature Dated: Commissioner/Judge of the Superior Court Dated: ORDER FOR PAYMENT OF COMPENSATION IT IS HEREIN ORDERED that a warrant for the sum of $ ______________, payable out of the general fund of the City and County of San Francisco be drawn by the City and County of San Francisco in favor of: NAME: SOCIAL SECURITY NO.: ADDRESS: CITY/STATE/ZIP CODE: TELEPHONE: FAX: Dated: Attorney Signature Date: Commissioner/Judge of the Superior Court NOTE: Please submit one (1) original and two (2) copies of the order with copies of invoice and any additional attachments. AUTHORIZATION FOR FUNDS FOR APPOINTMENT OF PRIVATE SOCIAL WORKER American LegalNet, Inc. www.FormsWorkFlow.com