PETITIONER OR ATTORNEY (Name and Address):



|ATTORNEY OR PARTY WITHOUT ATTORNEY | |FOR COURT USE ONLY |

| | | |

|NAME: | | |

|FIRM NAME: | | |

|STREET ADDRESS: | | |

|CITY: | | |

|TELEPHONE NO: |STATE: ZIP CODE: | |

|E-MAIL ADDRESS |FAX NO: | |

|ATTORNEY FOR (name): | | |

| | | |

|SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS | | |

|STREET ADDRESS: 2215 Blue Gum Avenue Room 15 | | |

|MAILING ADDRESS: 2215 Blue Gum Avenue Room 15 | | |

|CITY AND ZIP CODE: Modesto, California 95358 | | |

|BRANCH NAME: Juvenile | | |

| | |

|DECLARATION IN SUPPORT OF ACCESS TO AND COPIES OF JUVENILE COURT RECORDS (WIC § 827/828) | |

|IN THE MATTER OF: |CASE NUMBER: |

| | |

|a minor. | |

|Date of birth: | |

A. Person/agency entitled to view and receive copies:

1. Court personnel

2. The district attorney, a city attorney, or city prosecutor authorized to prosecute criminal or juvenile cases under state law

3. The minor who is the subject of the proceeding

4. The minor’s parent or legal guardian

5. Persons from an Indian tribe, reservation, or tribal court when the case file involves a minor who is/can be a member

6. The attorneys for the parties. BAR#____________________ Client____________________ Court_____________________

7. Probation officers and law enforcement officers actively participating in criminal or juvenile proceedings involving the minor

8. The county counsel, city attorney, or any other attorney representing the petitioning agency in a dependency action

9. Member of the child protective agencies as defined in Section 11165.9 of the Penal Code

10. The State Department of Social Services

11. OTHER:__________________________________________

B. Person/agency entitled to view ONLY:

1. The superintendent or designee of the school district where the minor is enrolled or attending school

2. Member of children’s multidisciplinary teams, persons, or agencies providing treatment or supervision of the minor

3. Court appointed investigator

4. Child support agency

5. Juvenile Justice Commission

6. DOJ

Any records, reports or information obtained from the above juvenile record(s) shall not be further released or disseminated to

Persons or agencies not otherwise entitled to access pursuant to WIC § 827/828. Said information shall not be attached to any

documents without prior approval of the Presiding Judge of the Juvenile Court, unless they are used in connection with adult criminal

or juvenile court proceedings to declare a minor a dependent or ward of the court.

C. I hereby request copies of the following documents:

All documents

Petition and disposition (specify date(s)):____________________________________________________________

Other:________________________________________________________________________________________

I declare under penalty of perjury pursuant to the laws of the State of California that the foregoing is true and correct:

DATE: __________________ Signature:_________________________________________

Agency:_____________________________ Printed Name:_____________________________________

JV001 Rev 4/12/19

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