Petitioner on information and belief alleges the following:
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):
a.
(a) (b)(1) (b)(2) (c) (d) (e) (f) (g) (h) (i) (j)
Child's name:
b.
Gender:
e.
JUVENILE DEPENDENCY PETITION (VERSION ONE)
Welfare and Institutions Code, § 300 et seq.;
Cal. Rules of Court, rule 5.504
www.courts.ca.gov
Form Adopted for Alternative Mandatory Use
Instead of Form JV-110
Judicial Council of California
JV-100 [Rev. January 1, 2020]
Page 1 of 2
2.
Indian Child Welfare Act Inquiry (check one):
(See important notice on page 2.)
CHILD'S NAME:
FOR COURT USE ONLY
CASE NUMBER:
JUVENILE DEPENDENCY PETITION (VERSION ONE)
(Welf. & Inst. Code, § 300 et seq.)
JV-100
RELATED CASE (if any):
ATTORNEY OR PARTY WITHOUT ATTORNEY
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
STATE BAR NO.:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
For counties filing a separate dependency petition for each child or for counties using Additional Children Attachment (form JV-101(A))
§ 300—Original
§ 342—Subsequent
§ 387—Supplemental
1.
Age:c. Date of birth:d.
Name:
Address:
If mother or father (check all that apply):
f.
mother
father
guardian
unknown
legal
biological
presumed
alleged
Name:
Address:
If mother or father (check all that apply):
g.
mother
father
guardian
unknown
legal
biological
presumed
alleged
Name:
Address:
If mother or father (check all that apply):
h.
mother
father
guardian
unknown
legal
biological
presumed
alleged
Prior to intervention, child resided with
parent (name):
guardian (name):
other (state name, address, and relationship to child):
Indian custodian (name):
j.
parent (name):
Other (state name, address, and relationship to child):
i.
No known parent or guardian resides within this state. This adult
relative lives in this county or is closest to this court.
Child is
Date and time of detention:
Current place of detention (address):
k.
not detained
detained
Relative
Shelter/foster care
Other
a.
I have asked as to whether the child is or may be a member of an Indian tribe or eligible for membership and the
biological child of a member and the Indian Child Inquiry Attachment (form ICWA-010(A)) is attached.
b.
On information and belief, I am aware that inquiry has been completed by (insert name)
and the Indian Child Inquiry Attachment (form ICWA-010(A)) is attached.
