Free JV-210 APPLICATION TO COMMENCE PROCEEDINGS BY AFFIDAVIT AND DECISION BY SOCIAL WORKER (Welf. & Inst. Code, § 329) - California

COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. :
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number if attorney, and mailing address):

Index No. Calendar No.

JV­210
FOR COURT USE ONLY

:
TELEPHONE NO. (Optional): E­MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional):

Plaintiff(s)

: : : :

JUDICIAL SUBPOENA

-against-

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

CHILD'S NAME:

Defendant(s) : ......................................................
APPLICATION TO COMMENCE PROCEEDINGS BY AFFIDAVIT AND DECISION BY SOCIAL WORKER
CASE NUMBER:

To the social worker or social services agency of (specify county): County: 1. Applicant's name and address: TO 2. Applicant's relationship to child (specify): 3. Applicant on information and belief alleges that the child is at risk of abuse or neglect and should come within the jurisdiction of the court (supply all information known): Child's name: GREETINGS: Age: Date of birth: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Sex: , the Honorable at the Court Mother's name: located at Mother's of County address: Father's name: in room , on the day of , 20 , at o'clock in the noon, and at any recessed Father's address: or adjourned date, to testify and give evidence as a witness in this action on the part of the Other (state name, address, and relationship to child): 4. The child described in item 3 above a. resides within this county. Your failure to comply the this subpoena is punishable as a contempt of court and will make you liable to b. was in this county at the time ofwithfacts alleged below. the support (State supporting facts concisely; include all known maximum dates, times, names, and addresses. Attach 5. Facts in party on whose behalf this subpoena was issued for a and relevant penalty of $50 and all damages sustained as a result of your failure to comply. separate pages as necessary.): a. b. c. d. e. f. g. h. i.

THE PEOPLE OF THE STATE OF NEW YORK

(Welf. & Inst. Code, § 329)

6. Applicant requests that the social worker or agency immediately commence proceedings in the juvenile court on behalf of this child.

Witness, Honorable Court in County,

See attachment 5.

, one of the Justices of the day of , 20

Date:
(Attorney must sign above and type name below)
(SIGNATURE OF APPLICANT)

(TYPE OR PRINT NAME)

DECISION OF SOCIAL WORKER OR SOCIAL SERVICES AGENCY
7. After consideration of the application above, the SOCIAL WORKER HAS DECIDED Attorney(s) for to commence proceedings in juvenile court on these allegations. a. b. not to commence proceedings in juvenile court on these allegations because (specify): See attachment 7. Number of pages attached ___. 8. I declare I am a social worker of the county in which this application was submitted, and duly authorized to make this decision.

Office and P.O. Address

Date:

(TYPE OR PRINT NAME) ADDRESS AND TELEPHONE NUMBER:

Form Approved for Optional Use Judicial Council of California JV­210 [New January 1, 2001]

Telephone No.: (SIGNATURE OF SOCIAL WORKER) Facsimile No.: E-Mail Address: Welfare and Institutions Code, § 329 Mobile BY AFFIDAVIT APPLICATION TO COMMENCE PROCEEDINGSTel. No.:
AND DECISION BY SOCIAL WORKER
(Welf. & Inst. Code, § 329)
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