AOC-DNA-13 Rev. 1-15 Page 1 of 2 Commonwealth of Kentucky Court of Justice www.courts.ky.gov FCRPP 17(2) ; FCRPP 29 KRS 610.125; 620.100 COM M O NW E A LT H O F K E lex et justitia Case No. ____________________ Court [ ] District [ ] Family County ______________________ Division _____________________ NT U C KY RT OF JUS TI NOTICE OF NAMES AND ADDRESSES OF INTERESTED PARTIES TO BE NOTICED BY CLERK FOR HEARINGS IN THE INTEREST OF: ____________________________________________________________________, A CHILD DOB Sex Race SSN CIRCUIT CLERK: IF THE FOLLOWING BOX IS CHECKED THIS NOTICE SHOULD NOT TO BE RELEASED WITHOUT AN ORDER FROM THE COURT. [ ] DCBS hereby requests that the address(es) of _______________________________________________________________________________________________ not be released to the following persons: _______________________________________________________________________________________________ _______________________________________________________________________________________________ without an Order from the Court for the following reasons: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Pursuant to FCRPP 29 and FCRPP 17(2), the Cabinet for Health and Family Services, Department for Community Based Services, hereby submits the following information to the Court relating to the names and addresses of the foster parent(s), if any; person(s) or agency providing care to the child and any pre-adoptive parent(s) who may not currently be providing care; court appointed special advocate (CASA), if any; and, foster care review board member assigned to the case so that the Clerk of the Court can provide notice of the hearing and the right of the foster parent(s), person(s)/agency providing care for the child, pre-adoptive parent(s) if any, of their right to be heard. Foster Parent(s) (if any) Name and Address: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Person(s) or Agency Providing Care (if any) Name and Address: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Pre-Adoptive Parent(s) (if any) Name and Address: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com C CO U E AOC-DNA-13 Rev. 1-15 Page 2 of 2 Case No. ___________________________ CASA volunteer (if any) Name and Address: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ CFCRB Member Name and Address: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Is this a change from any prior notice of interested persons? [ ] Yes [ ] No If yes, list persons previously provided to the Court who are no longer entitled to receive notice: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Filed by: _______________________________________________ DCBS Worker ____________________________________________ Date Distribution: [ ] Court File American LegalNet, Inc. www.FormsWorkFlow.com