Free Dependency Motion for Transfer (JC\E-325) - California

FOR COURT USE ONLY

SACRAMENTO COUNTY DHHS

Telephone no: (916) 875-XXXX

Fax no:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO STREET ADDRESS: 3341 Power Inn Road
MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CHILD'S NAME:

Sacramento, California 95826 Sac. County Juvenile Court
CASE NUMBER:

DEPENDENCY MOTION FOR TRANSFER (Social Worker is to call the court department clerk and get a date/time for a hearing if transfer-out is being recommended in-between hearings)

Date: Time: Dept:

1.

Disposition not yet ordered Disposition ordered on: Long term placement ­ The Department in the proposed transfer in county has agreed the transfer is in the best interest of the child.

2.

Transfer in County: County receiving transfer is a member of the local protocol.

3.

Reasons for transfer (including why this is in the best interest of the child):

.

4.

The parents'/legal guardian's address was confirmed by Name: Street Address: City, State, Zip Telephone:

(name),

(title), in

County as:

5.

Last Sacramento school district: Child has an IEP.

6.

The proposed transfer-in county can offer the following services (check all that apply): Alcohol and Drug treatment program Drug testing
DEPENDENCY MOTION FOR TRANSFER

Name Court no. JC\E-325 3/06

Parenting classes Counseling: Family/Individual Counseling: Anger Management/Domestic Violence 7.

Educational Services Counseling: Sexual Abuse/Offender Other (specify): .

The applicability of the Indian Child Welfare Act has been determined. See minute order dated

8.

Paternity has been determined. See minute order dated Not Applicable

.

9.

A Welfare and Institutions Code section 241.1 determination has been made. See minute order dated Not Applicable

.

10.

The petitioner has notified the following parties and attorneys of the requested transfer (state names of persons notified and relationship to the child or the case): Mother's Attorney: Father's Attorney: Child's Attorney: County Counsel: Other Attorney: Other Attorney: Date of Notice: Date of Notice: Date of Notice: Date of Notice: Date of Notice: Date of Notice:

Social Worker:
(print or type name)

Social Worker: ___________________________________ Date: _______________

Social Worker Supervisor:
(print or type name)

Social Worker Supervisor: _________________________________ Date: _______________

Name Court no. JC\E-325 3/06

DEPENDENCY MOTION FOR TRANSFER