Application submitted by: (Name and Address) Name: Street Address City, State: Telephone Number: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO Street Address: 3341 Power Inn Road City and Zip Code: Sacramento, CA 95826 SITTING AS THE JUVENILE COURT Branch Name: NAME OF CHILD/MINOR: Date of Birth:
FOR DEPARTMENT OR COURT USE ONLY
REQUEST TO APPOINT SACRAMENTO COURT APPOINTED SPECIAL ADVOCATES (CASA) (Welfare & Institutions Code ยง 102, California Rules of Court, rule 5.655,
Standing Order SSC-JV-00-028)
CASE NUMBER:
I, ________________________________________________________________, do hereby declare that:
I am:
the Child
the CASA Executive Director/designee
the Child's _____________________________________________________________ I believe the Child's best interest would be served by appointing Sacramento Court Appointed Special Advocates (CASA) to perform the duties described in Standing Order SSC-JV-00-028. I therefore request this Court appoint CASA to assist the Child. I declare under penalty of perjury that the above is true and correct. Executed this _________ day of __________________________________ in Sacramento, California. Signature: __________________________________________________
ORDER It is the order of this Court that Sacramento Court Appointed Special Advocates (CASA) is appointed pursuant to Standing Order SSC-JV-00-028.
Date: ______________________________
________________________________ Judge/Referee of the Juvenile Court
JC\E-338 Eff. 2/26/09
Request for Juvenile Court to Appoint CASA