ATTACHMENT JV-2002a ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: FOR COURT USE ONLY ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA Street Address: Mailing Address: Branch Name: 115 Terraine Street, San José, CA 95113 191 North First Street, San José, CA 95113 Juvenile Dependency In the Matter of: (Name of Child), a Minor. [D.O.B. _________ ] CASE NUMBER: DECLARATION FOR JUVENILE COURT RECORD (DEPENDENCY) I am: 1. 2. 3. 4. 5. 6. 7. 8. 9. Child or Former Dependent Mother of the named juvenile Father of the named juvenile Guardian of the named juvenile Court-Appointed Special Advocate (CASA) District Attorney - State Bar Number: Attorney - State Bar Number: Sixth Appellate District Program Member Other: (specify) Representing: (name, "AKA" and DOB) (name, "AKA" and DOB) (name, "AKA" and DOB) 10. Address: 11. I am requesting to view the following record(s) relating to the minor: 12. Which are held by: a. b. 13. Court Clerk, Juvenile Dependency Division Department of Family & Children Services I request copies of the following record(s) [copies of records may be subject to a fee pursuant to statute]: Use of juvenile records is subject to Petition under Welfare & Institutions Code § 827 [JV-570] and further Court authorization. I understand these records are confidential. I declare under penalty of perjury the forgoing is true and correct. Dated this day of , 20 , at San José, California Signature: Type or print name: JV-2002a REV. 07/01/13 DECLARATION FOR JUVENILE COURT RECORD (DEPENDENCY) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com