Free JV-122.v4.092606.mc.ofm - California

JV-122
CHILD'S NAME:
CASE NUMBER:

SERIOUS EMOTIONAL DAMAGE
§ 300(c) The child is suffering, or is at substantial risk of suffering, serious emotional damage evidenced by severe anxiety, depression, withdrawal, or untoward aggressive behavior toward self or others as a result of the conduct of the parent or guardian. because the child has no parent or guardian capable of providing appropriate care. (State supporting facts concisely and number them c-1, c-2, c-3, etc.):

Page Form Approved for Optional Use Judicial Council of California JV-122 [Rev. January 1, 2007]

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SERIOUS EMOTIONAL DAMAGE § 300(c)

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