Free IN THE SUPERIOR COURT FOR THE STATE OF ALASKA - Alaska

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT

In the Matter of (use child's initials only):

A minor under 18 years of age. Date of Birth:

) ) ) ) ) )

CASE NO. REQUEST FOR REVIEW HEARING ON VISITATION

I am a parent, an adult family member, or the guardian of the minor child named above. The Office of Children's Services has denied me reasonable visitation with the child. As an

interested person, I ask the court for a review hearing on this matter. I understand that I am not eligible for publicly appointed legal counsel.

Date I certify that on I sent copies of this request to: City Clerk:

Signature Type or Print Name Mailing Address State & ZIP Daytime Phone Number

ORDER IT IS ORDERED that the request for review hearing is DENIED. Good cause for a review hearing has not been demonstrated. GRANTED. A review hearing will be held on a.m./p.m., at at

Date

Judge

I certify that on I sent copies of this order to:

Type or Print Name

Clerk:

CN-365 (1/06)(cs) REQUEST FOR REVIEW HEARING ON VISITATION

AS 47.10.080(p)