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Here is the text we could read:

ATTORNEY OR PARTY WITHOUT ATTORNEY:

STATE BAR NO.:

JV-237

FOR COURT USE ONLY

STATE:

FAX NO.:

ZIP CODE:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

NAME:

FIRM NAME:

STREET ADDRESS:

CITY:

TELEPHONE NO.:

EMAIL ADDRESS:

ATTORNEY FOR (name):

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

CHILD'S/NONMINOR'S NAME: 
CHILD'S/NONMINOR'S DATE OF BIRTH:
HEARING DATE AND TIME:

I served a copy of

Proof of Service—Short-Term Residential Therapeutic Program or 
Community Treatment Facility Placement

CASE NUMBER:

Placing Agency's Request for Review of Placement in Short-Term Residential Therapeutic Program or Community Treatment 
Facility (form JV- 235) AND a blank copy of Input on Placement in Short-Term Residential Therapeutic Program or 
Community Treatment Facility (form JV-236), AND/OR
the report as described in Welf. & Inst. Code, § 361.22(c) or § 727.12(c) for a hearing on (date):

, AND/OR

Notice of Request for Approval of Short-Term Residential Therapeutic Program or Community Treatment Facility Without a 
Hearing (form JV-240), if requesting approval of the placement without a hearing

on the following persons or entities by
•  personally delivering a copy to the person served, OR
•  by delivering a copy to a competent adult at the usual place of residence or business of the person served and thereafter 

mailing a copy by first-class mail to the person served at the place where the copy was delivered, OR

•  by placing a copy in a sealed envelope and depositing the envelope directly in the U.S. mail with postage prepaid, or at my 
place of business for same-day collection or mailing with the U.S. mail following our ordinary business practices with which I 
am readily familiar, OR

•  by delivering a copy by electronic means at the electronic service address indicated below (electronic service must comply with 

Welf. & Inst. Code, § 212.5):

1. a.

The child (if 10 years of age or older) or the nonminor 
dependent

1. b.

Attorney or Child Abuse Prevention and Treatment 
Act (CAPTA) guardian ad litem

(1) Name:
(2) Mailing, in-person, or electronic service address: 

(1) Name:

(2) Mailing, in-person, or electronic service address: 

(3) Date of service:
(4) Method of service:

(3) Date of service:
(4) Method of service:

2. a.

Parent/Legal Guardian

2. b.

Attorney

(1) Name:
(2) Mailing, in-person, or electronic service address:

(1) Name:
(2) Mailing, in-person, or electronic service address: 

(3) Date of service:
(4) Method of service:

(3) Date of service:
(4) Method of service:

3. a.

Parent/Legal Guardian

3. b.

Attorney

(1) Name:
(2) Mailing, in-person, or electronic service address:

(1) Name:
(2) Mailing, in-person, or electronic service address: 

(3) Date of service:
(4) Method of service:

Form Adopted For Mandatory Use 
Judicial Council of California 
JV-237 [Rev. January 1, 2023] 

(3) Date of service:
(4) Method of service:

Proof of Service—Short-Term  
Residential Therapeutic Program or Community 
Treatment Facility Placement

Page 1 of 2

Welfare and Institutions Code, 
§§ 361.22, 727.12; 
Cal. Rules of Court, rule 5.618

CHILD'S/NONMINOR'S NAME:

CASE NUMBER:

JV-237

4. a.

The child's or nonminor dependent’s Indian tribe

4. b.

Attorney

(1) Name:
(2) Mailing, in-person, or electronic service address:

(1) Name:
(2) Mailing, in-person, or electronic service address: 

(3) Date of service:
(4) Method of service:

(3) Date of service:
(4) Method of service:

5. a.

Indian custodian

5. b.

Attorney

(1) Name:
(2) Mailing, in-person, or electronic service address:

(1) Name:
(2) Mailing, in-person, or electronic service address: 

(3) Date of service:
(4) Method of service:

(3) Date of service:
(4) Method of service:

6.

CASA volunteer

7.

Other (specify):

a. Name:
b. Mailing, in-person, or electronic service address: 

a. Name:
b. Mailing, in-person, or electronic service address: 

c. Date of service:
d. Method of service:

9.

Other (specify):

c. Date of service:
d. Method of service:

a. Name:
b. Mailing, in-person, or electronic service address: 

a. Name:
b. Mailing, in-person, or electronic service address: 

10. At the time of service I was at least 18 years of age. If service was made in person, by mail, or electronic service, I am not a party 
to this matter. I am a resident of or employed in the county where the service occurred. My residence or business mailing address,
or my electronic service address, is (specify address):

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

c. Date of service:
d. Method of service:

8.

Other (specify):

c. Date of service:
d. Method of service:

Date:

Type or print your name

Sign your name

JV-237 [Rev. January 1, 2023]

Page 2 of 2

Proof of Service—Short-Term  
Residential Therapeutic Program or Community 
Treatment Facility Placement

Proof of Service—Short-Term Residential Therapeutic Program Placement

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 2
Fields(s): 99
Average fields per page: 49
Reading Level: Grade 7
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

j_v_page_atty_info_bar_dc was JV-237[0].Page1[0].AttyInfo[0].AttyBarNo_dc[0] (0.52 conf)
j_v_page_atty_info_name_ft was JV-237[0].Page1[0].AttyInfo[0].AttyName_ft[0] (0.36 conf)
j_v_page_atty_info_firm_ft was JV-237[0].Page1[0].AttyInfo[0].AttyFirm_ft[0] (0.38 conf)
j_v_page_atty_info_street_ft was JV-237[0].Page1[0].AttyInfo[0].AttyStreet_ft[0] (0.36 conf)
j_v_page_atty_info_city_ft was JV-237[0].Page1[0].AttyInfo[0].AttyCity_ft[0] (0.41 conf)
j_v_page_atty_info_state_ft was JV-237[0].Page1[0].AttyInfo[0].AttyState_ft[0] (0.36 conf)
j_v_page_atty_info_zip_ft was JV-237[0].Page1[0].AttyInfo[0].AttyZip_ft[0] (0.34 conf)
j_v_page_atty_info_phone_ft was JV-237[0].Page1[0].AttyInfo[0].Phone_ft[0] (0.39 conf)
j_v_page_atty_info_fax_ft was JV-237[0].Page1[0].AttyInfo[0].Fax_ft[0] (0.38 conf)
j_v_page_atty_info_email_ft was JV-237[0].Page1[0].AttyInfo[0].Email_ft[0] (0.40 conf)
j_v_page_atty_info_ft was JV-237[0].Page1[0].AttyInfo[0].AttyFor_ft[0] (0.40 conf)
j_v_page_court_county_ft was JV-237[0].Page1[0].CourtInfo[0].CrtCounty_ft[0] (0.40 conf)
j_v_page_court_street_ft was JV-237[0].Page1[0].CourtInfo[0].Street_ft[0] (0.38 conf)
j_page_court_info_add_ft was JV-237[0].Page1[0].CourtInfo[0].MailingAdd_ft[0] (0.32 conf)
j_v_page_court_info_city_zip_ft was JV-237[0].Page1[0].CourtInfo[0].CityZip_ft[0] (0.30 conf)
j_v_page_court_branch_ft was JV-237[0].Page1[0].CourtInfo[0].Branch_ft[0] (0.36 conf)
j_page_title_party_name_non__1 was JV-237[0].Page1[0].TitlePartyName[0].NonMinorsName_ft[0] (0.34 conf)
j_page_title_party_name_non__2 was JV-237[0].Page1[0].TitlePartyName[0].NonMinorsDOB_ft[0] (0.35 conf)
page_title_party_name_hearing_time was JV-237[0].Page1[0].TitlePartyName[0].HearingTimeDate_ft[0] (0.34 conf)
j_v_page_case_number_ft__1 was JV-237[0].Page1[0].CaseNumber[0].CaseNumber_ft[0] (0.31 conf)
j_v_page_serve_copy_sub_placingagencyreq was JV-237[0].Page1[0].ServeCopy_sub[0].placingagencyreq[0] (0.31 conf)
j_v_page_serve_copy_sub_thereportastx was JV-237[0].Page1[0].ServeCopy_sub[0].thereportastx[0] (0.31 conf)
j_v_page_serve_copy_sub_hearing_date was JV-237[0].Page1[0].ServeCopy_sub[0].HearingDate[0] (0.32 conf)
j_v_page_serve_copy_sub_noticeofreqtx was JV-237[0].Page1[0].ServeCopy_sub[0].noticeofreqtx[0] (0.31 conf)
j_v_page_item_thechildbx was JV-237[0].Page1[0].Item1a[0].thechildbx[0] (0.32 conf)
j_v_page_item_name_afill was JV-237[0].Page1[0].Item1a[0].name1afill[0] (0.32 conf)
j_v_page_item_mailingfill was JV-237[0].Page1[0].Item1a[0].mailingfill[0] (0.32 conf)
j_v_page_item_dateofservfill was JV-237[0].Page1[0].Item1a[0].dateofservfill[0] (0.32 conf)
j_v_page_item_methodofservfill was JV-237[0].Page1[0].Item1a[0].methodofservfill[0] (0.32 conf)
j_v_page_item_b_check_box was JV-237[0].Page1[0].item1b[0].CheckBox1b[0] (0.27 conf)
j_v_page_item_b_namefillb was JV-237[0].Page1[0].item1b[0].namefillb[0] (0.35 conf)
j_v_page_item_b_mailingfill was JV-237[0].Page1[0].item1b[0].mailingfill[0] (0.35 conf)
j_v_page_item_b_dateofserv was JV-237[0].Page1[0].item1b[0].dateofserv1b3[0] (0.35 conf)
j_v_page_item_b_method was JV-237[0].Page1[0].item1b[0].method[0] (0.35 conf)
j_v_page_item_parentlegal was JV-237[0].Page1[0].item2a[0].parentlegal[0] (0.35 conf)
j_v_page_item_name__1 was JV-237[0].Page1[0].item2a[0].name2a[0] (0.35 conf)
j_v_page_item_mailinginpers was JV-237[0].Page1[0].item2a[0].mailinginpers[0] (0.35 conf)
j_v_page_item_dateofservice__1 was JV-237[0].Page1[0].item2a[0].dateofservice[0] (0.35 conf)
j_v_page_item_methodofservice__1 was JV-237[0].Page1[0].item2a[0].methodofservice[0] (0.35 conf)
j_v_page_item_b_attorneychbx__1 was JV-237[0].Page1[0].item2b[0].attorneychbx[0] (0.35 conf)
j_v_page_item_b_name__1 was JV-237[0].Page1[0].item2b[0].name[0] (0.35 conf)
j_v_page_item_b__1 was JV-237[0].Page1[0].item2b[0].mailinginperson[0] (0.35 conf)
j_v_page_item_b_dateofservice__1 was JV-237[0].Page1[0].item2b[0].dateofservice[0] (0.35 conf)
j_v_page_item_b__2 was JV-237[0].Page1[0].item2b[0].methodofservice[0] (0.35 conf)
j_v_page_item__1 was JV-237[0].Page1[0].item3a[0].parentlegalguardian[0] (0.35 conf)
j_v_page_item_name__2 was JV-237[0].Page1[0].item3a[0].name3a[0] (0.35 conf)
j_v_page_item_mailininperson was JV-237[0].Page1[0].item3a[0].mailininperson2[0] (0.35 conf)
j_v_page_item_dateofservice__2 was JV-237[0].Page1[0].item3a[0].dateofservice[0] (0.35 conf)
j_v_page_item_methodofservice__2 was JV-237[0].Page1[0].item3a[0].methodofservice[0] (0.35 conf)
j_v_page_item_b_attorneychbx__2 was JV-237[0].Page1[0].item3b[0].attorneychbx[0] (0.35 conf)
j_v_page_item_b_namechbx was JV-237[0].Page1[0].item3b[0].namechbx[0] (0.35 conf)
j_v_page_item_b_mailingbx was JV-237[0].Page1[0].item3b[0].mailingbx[0] (0.35 conf)
j_v_page_item_b_dateofservice__2 was JV-237[0].Page1[0].item3b[0].dateofservice[0] (0.35 conf)
j_v_page_item_b__3 was JV-237[0].Page1[0].item3b[0].methodofservice[0] (0.35 conf)
j_v_page_non_name_ft was JV-237[0].Page2[0].header2[0].NonMinorsName_ft[0] (0.36 conf)
j_v_page_case_number_ft__2 was JV-237[0].Page2[0].header2[0].CaseNumber_ft[0] (0.34 conf)
j_v_page_item_chechbxthechild was JV-237[0].Page2[0].item4a[0].chechbxthechild[0] (0.35 conf)
j_v_page_item_name__3 was JV-237[0].Page2[0].item4a[0].name2[0] (0.35 conf)
j_v_page_item_mailing was JV-237[0].Page2[0].item4a[0].mailing[0] (0.35 conf)
j_v_page_item_dateofservice__3 was JV-237[0].Page2[0].item4a[0].dateofservice[0] (0.35 conf)
j_v_page_item_methodofserv was JV-237[0].Page2[0].item4a[0].methodofserv[0] (0.35 conf)
j_v_page_item_b_attorney was JV-237[0].Page2[0].item4b[0].attorney4[0] (0.35 conf)
j_v_page_item_b_name__2 was JV-237[0].Page2[0].item4b[0].name2[0] (0.35 conf)
j_v_page_item_b_mailing__1 was JV-237[0].Page2[0].item4b[0].mailing2[0] (0.35 conf)
j_v_page_item_b_dateofservice__3 was JV-237[0].Page2[0].item4b[0].dateofservice[0] (0.35 conf)
j_v_page_item_b__4 was JV-237[0].Page2[0].item4b[0].methodofservice[0] (0.35 conf)
j_v_page_item__2 was JV-237[0].Page2[0].item5a[0].indiancustodianchbx[0] (0.35 conf)
j_v_page_item_name__4 was JV-237[0].Page2[0].item5a[0].name5a2[0] (0.35 conf)
j_v_page_item_mailinginperson__1 was JV-237[0].Page2[0].item5a[0].mailinginperson[0] (0.35 conf)
j_v_page_item_dateofservice__4 was JV-237[0].Page2[0].item5a[0].dateofservice[0] (0.35 conf)
j_v_page_item_methodofservice__3 was JV-237[0].Page2[0].item5a[0].methodofservice[0] (0.35 conf)
j_v_page_item_b_attorneychbx__3 was JV-237[0].Page2[0].item5b[0].attorneychbx[0] (0.35 conf)
j_v_page_item_b_name__3 was JV-237[0].Page2[0].item5b[0].name5b2[0] (0.35 conf)
j_v_page_item_b_mailing__2 was JV-237[0].Page2[0].item5b[0].mailing2[0] (0.35 conf)
j_v_page_item_b_dateofservice__4 was JV-237[0].Page2[0].item5b[0].dateofservice[0] (0.35 conf)
j_v_page_item_b__5 was JV-237[0].Page2[0].item5b[0].methodofservice[0] (0.35 conf)
j_v_page_item_casavolunteer was JV-237[0].Page2[0].item6[0].casavolunteer[0] (0.35 conf)
j_v_page_item_namea__1 was JV-237[0].Page2[0].item6[0].namea[0] (0.35 conf)
j_v_page_item_mailinginperson__2 was JV-237[0].Page2[0].item6[0].mailinginperson[0] (0.35 conf)
j_v_page_item_dateofservice__5 was JV-237[0].Page2[0].item6[0].dateofservice[0] (0.35 conf)
j_v_page_item_methodofservice__4 was JV-237[0].Page2[0].item6[0].methodofservice[0] (0.35 conf)
j_v_page_item_otherspecify was JV-237[0].Page2[0].item7[0].otherspecify[0] (0.35 conf)
j_v_page_item_namea__2 was JV-237[0].Page2[0].item7[0].namea1[0] (0.35 conf)
j_v_page_item_mailinginperson__3 was JV-237[0].Page2[0].item7[0].mailinginperson[0] (0.35 conf)
j_v_page_item_dateofservice__6 was JV-237[0].Page2[0].item7[0].dateofservice[0] (0.35 conf)
j_v_page_item_methodofservice__5 was JV-237[0].Page2[0].item7[0].methodofservice[0] (0.35 conf)
j_v_page_item_othercheckbox__1 was JV-237[0].Page2[0].item8[0].othercheckbox[0] (0.35 conf)
j_v_page_item_namea__3 was JV-237[0].Page2[0].item8[0].namea1[0] (0.35 conf)
j_v_page_item_mailinginperson__4 was JV-237[0].Page2[0].item8[0].mailinginperson[0] (0.35 conf)
j_v_page_item_dateofservice__7 was JV-237[0].Page2[0].item8[0].dateofservice[0] (0.35 conf)
j_v_page_item_methodofservice__6 was JV-237[0].Page2[0].item8[0].methodofservice[0] (0.35 conf)
j_v_page_item_othercheckbox__2 was JV-237[0].Page2[0].item9[0].othercheckbox[0] (0.35 conf)
j_v_page_item_name_tf was JV-237[0].Page2[0].item9[0].name_tf[0] (0.35 conf)
j_v_page_item_mailing_tf was JV-237[0].Page2[0].item9[0].mailing_tf[0] (0.35 conf)
j_v_page_item_dateofserv_tf was JV-237[0].Page2[0].item9[0].dateofserv_tf[0] (0.35 conf)
j_v_page_item_methodofservice__7 was JV-237[0].Page2[0].item9[0].methodofservice9[0] (0.35 conf)
j_v_page_item_ormyelect_tf was JV-237[0].Page2[0].item10[0].ormyelect_tf[0] (0.35 conf)
j_v_page_ideclare_sig_date was JV-237[0].Page2[0].ideclare[0].SigDate[0] (0.30 conf)
j_v_page_ideclare_typename was JV-237[0].Page2[0].ideclare[0].typename[0] (0.35 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

j_v_page_atty_info_bar_dc
j_v_page_atty_info_name_ft
j_v_page_atty_info_firm_ft
j_v_page_atty_info_street_ft
j_v_page_atty_info_city_ft
j_v_page_atty_info_state_ft
j_v_page_atty_info_zip_ft
j_v_page_atty_info_phone_ft
j_v_page_atty_info_fax_ft
j_v_page_atty_info_email_ft
j_v_page_atty_info_ft
j_v_page_court_county_ft
j_v_page_court_street_ft
j_page_court_info_add_ft
j_v_page_court_info_city_zip_ft
j_v_page_court_branch_ft
j_page_title_party_name_non__1
j_page_title_party_name_non__2
page_title_party_name_hearing_time
j_v_page_case_number_ft__1
j_v_page_serve_copy_sub_placingagencyreq
j_v_page_serve_copy_sub_thereportastx
j_v_page_serve_copy_sub_hearing_date
j_v_page_serve_copy_sub_noticeofreqtx
j_v_page_item_thechildbx
j_v_page_item_name_afill
j_v_page_item_mailingfill
j_v_page_item_dateofservfill
j_v_page_item_methodofservfill
j_v_page_item_b_check_box
j_v_page_item_b_namefillb
j_v_page_item_b_mailingfill
j_v_page_item_b_dateofserv
j_v_page_item_b_method
j_v_page_item_parentlegal
j_v_page_item_name__1
j_v_page_item_mailinginpers
j_v_page_item_dateofservice__1
j_v_page_item_methodofservice__1
j_v_page_item_b_attorneychbx__1
j_v_page_item_b_name__1
j_v_page_item_b__1
j_v_page_item_b_dateofservice__1
j_v_page_item_b__2
j_v_page_item__1
j_v_page_item_name__2
j_v_page_item_mailininperson
j_v_page_item_dateofservice__2
j_v_page_item_methodofservice__2
j_v_page_item_b_attorneychbx__2
j_v_page_item_b_namechbx
j_v_page_item_b_mailingbx
j_v_page_item_b_dateofservice__2
j_v_page_item_b__3
j_v_page_non_name_ft
j_v_page_case_number_ft__2
j_v_page_item_chechbxthechild
j_v_page_item_name__3
j_v_page_item_mailing
j_v_page_item_dateofservice__3
j_v_page_item_methodofserv
j_v_page_item_b_attorney
j_v_page_item_b_name__2
j_v_page_item_b_mailing__1
j_v_page_item_b_dateofservice__3
j_v_page_item_b__4
j_v_page_item__2
j_v_page_item_name__4
j_v_page_item_mailinginperson__1
j_v_page_item_dateofservice__4
j_v_page_item_methodofservice__3
j_v_page_item_b_attorneychbx__3
j_v_page_item_b_name__3
j_v_page_item_b_mailing__2
j_v_page_item_b_dateofservice__4
j_v_page_item_b__5
j_v_page_item_casavolunteer
j_v_page_item_namea__1
j_v_page_item_mailinginperson__2
j_v_page_item_dateofservice__5
j_v_page_item_methodofservice__4
j_v_page_item_otherspecify
j_v_page_item_namea__2
j_v_page_item_mailinginperson__3
j_v_page_item_dateofservice__6
j_v_page_item_methodofservice__5
j_v_page_item_othercheckbox__1
j_v_page_item_namea__3
j_v_page_item_mailinginperson__4
j_v_page_item_dateofservice__7
j_v_page_item_methodofservice__6
j_v_page_item_othercheckbox__2
j_v_page_item_name_tf
j_v_page_item_mailing_tf
j_v_page_item_dateofserv_tf
j_v_page_item_methodofservice__7
j_v_page_item_ormyelect_tf
j_v_page_ideclare_sig_date
j_v_page_ideclare_typename

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Proof of Service—Short-Term Residential Therapeutic Program Placement

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02