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JV-100
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
TELEPHONE NO.:
FAX NO. (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
CHILD'S NAME:
CASE NUMBER:
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):
(j)(f) (i)
(a) (b) (c) (d) (e) (h)
(g)
b. Child's name:
d. Date of birth: e. Sex:c. Age:
f. Name: g. Name:
Address: Address:
h. Name: i. Other (state name, address, and relationship to child):
No known parent or guardian resides within this state. This adult
relative lives in this county or is closest to this court.
k. Child isj. Prior to intervention, child resided with
not detained
detained
Date and time of detention:
Relative
Shelter/foster care Other
JUVENILE DEPENDENCY PETITION (VERSION ONE)
Cal. Rules of Court, rule 5.504
Welfare and Institutions Code, § 300 et seq.;
Form Adopted for Alternative Mandatory Use
Instead of Form JV-110
Judicial Council of California
JV-100 [Rev. July 1, 2008]
Current place of detention (address):
unknown
mother
father
guardian
unknown
mother
father
guardian
Address:
unknown
mother
father
guardian
parent (name):
parent (name):
guardian (name):
other (state name, address, and relationship to child):
www.courtinfo.ca.gov
Page 1 of 2
E-MAIL ADDRESS (Optional):
If mother or father (check all that apply):
legal
biological
presumed
alleged
If mother or father (check all that apply):
legal
biological
presumed
alleged
If mother or father (check all that apply):
legal
biological
presumed
alleged
JUVENILE DEPENDENCY PETITION (VERSION ONE)
(Welf. & Inst. Code, § 300 et seq.)
§ 342—Subsequent § 387—Supplemental § 300—Original
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.)
Indian custodian (name):