ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
TELEPHONE NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name):
FAX NO. (Optional)
SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO
ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NUMBER: PETITIONER/PLAINTIFF: ___________________________________________ RESPONDENT/DEFENDANT: HEARING DATE: TIME: DEPT.:
JUVENILE DIVISION
CERTIFICATION OF ATTORNEY COMPETENCY
I,
Name Office Address Telephone Number
am an
Attorney at law licensed to practice in the State of California. My State Bar Number is . I hereby certify that I meet the minimum standards for practice before a Juvenile Court set forth in California Rules of Court, rule 5.660, and local rule 16.19 and that I have completed the minimum requirements for training, education and/or experience as set forth below. Training and Education: (Attach copies of MCLE certificates or other documentation of attendance) Course Title Date Completed Hours Provider
Summary of Juvenile Dependence Experience: Dated:
Signature
In RE: Case No: Certification of Attorney Competency Dated:
MJV-100-local