Free JV-100 Juvenile Dependency Petition (Version One) - California

For counties filing a separate dependency petition for each child or for counties using Additional Children Attachment (form JV-101(A))
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

JV-100

TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name):

FAX NO. (Optional):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

CHILD'S NAME:
CASE NUMBER:

JUVENILE DEPENDENCY PETITION (VERSION ONE)
(Welf. & Inst. Code, § 300 et seq.) § 300--Original § 342--Subsequent § 387--Supplemental

RELATED CASES (if any):

1. Petitioner on information and belief alleges the following: a. The child named below comes within the jurisdiction of the juvenile court under the following subdivisions of section 300 of the Welfare and Institutions Code (check applicable boxes; see attachment 1a for concise statements of facts): (a) (b) (c) (d) (e) (g) (h) (f) (i) (j) b. Child's name: c. Age: d. Date of birth: e. Sex: f. Name: Address: mother father guardian unknown
presumed alleged

g. Name: Address:

mother father guardian unknown
presumed alleged

If mother or father (check all that apply): biological legal

If mother or father (check all that apply): biological legal

h. Name: Address:

mother father guardian unknown

i.

Other (state name, address, and relationship to child):

If mother or father (check all that apply): biological legal

presumed

alleged

No known parent or guardian resides within this state. This adult relative lives in this county or is closest to this court.

j. Prior to intervention, child resided with parent (name): parent (name): guardian (name): Indian custodian (name): other (state name, address, and relationship to child):

k. Child is detained not detained Date and time of detention: Current place of detention (address):

Relative

Shelter/foster care

Other

2. I have asked about Indian ancestry for this child and have completed and attached the required Indian Child Inquiry Attachment, form ICWA-010(A). (If this is a subsequent filing and there is no new information, the ICWA-010(A) is not required.)

(See important notice on page 2.)
Form Adopted for Alternative Mandatory Use Instead of Form JV-110 Judicial Council of California JV-100 [Rev. July 1, 2008]

JUVENILE DEPENDENCY PETITION (VERSION ONE)

Page 1 of 2 Welfare and Institutions Code, § 300 et seq.; Cal. Rules of Court, rule 5.504 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com

JV-100
CHILD'S NAME:
CASE NUMBER:

3. Petitioner requests that the court find these allegations to be true. I declare under penalty of perjury under the laws of the State of California that the foregoing and all attachments are true and correct. Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF PETITIONER)

Address and telephone number (if different person signing than listed in caption above):

Number of pages attached:

Other children are listed on Additional Children Attachment (form JV-101(A))

-- NOTICE --
TO PARENT
Your parental rights may be permanently terminated. To protect your rights, you must appear in court and answer this petition.

TO PARENTS OR OTHERS LEGALLY RESPONSIBLE FOR THE SUPPORT OF THE CHILD
You and the estate of your child may be jointly and severally liable for the cost of the care, support, and maintenance of your child in any placement or detention facility, the cost of legal services for you or your child by a public defender or other attorney, and the cost of supervision of your child by order of the juvenile court.

JV-100 [Rev. July 1, 2008]

JUVENILE DEPENDENCY PETITION (VERSION ONE)

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