State of Minnesota County Judicial District: Court File Number: Case Type: District Court Juvenile In the Matter of the Welfare of the Child(ren) of: Parent Parent To: Legal Custodian Legal Custodian Notice of Motion and Motion to Intervene as a Party The Court The Parties or, if represented, their attorneys Please take notice that pursuant to Rule 23.02 of the Rules of Juvenile Protection Procedure, on ______________________ at ______ o'clock __.m. at the Date Time Name of Building courthouse or government center located at Street Address , in the City of __________________________, Minnesota, I will ask the court for an order City granting me permission to intervene as a party in this matter. 1. My name is: First Name My address is: Street Address City 2. State Apt. No. Zip Code Last Name My relationship to the child(ren) is as follows (explain your relationship to the child(ren), such as foster parent, adoptive parent, relative, school district, friend of the family): 3. I wish to intervene as a party, and my intervention is in the best interests of the child(ren), because (explain why you want to become a party and why that would be best for the child(ren) involved): 4. At the hearing on this matter other parties will have the right to object to my intervention as a party. Dated: Petitioner `s Signature CHP402 State ENG Rev 7/04-D www.mncourts.gov/forms Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com