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Here is the text we could read:

ATTORNEY OR PARTY WITHOUT ATTORNEY

STATE BAR NUMBER:

FOR COURT USE ONLY

JV-210

STATE:

FAX NO.:

ZIP CODE:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

NAME:

FIRM NAME:

STREET ADDRESS:

CITY:

TELEPHONE NO.:

EMAIL ADDRESS:

ATTORNEY FOR (name):

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

CHILD'S NAME:

APPLICATION TO COMMENCE JUVENILE COURT PROCEEDINGS
AND DECISION OF SOCIAL WORKER
(Welfare & Institutions Code, § 329)

CASE NUMBER:

Instructions: All applicants, complete part I. Individuals, complete part II, not part III. Probate court, skip part II and complete part III.

To the social worker or the child welfare agency of the county named above:

PART I. CHILD'S INFORMATION

1. a. Child's name:

b. Age:
c. Date of birth:
d. Sex:
e.

(1) Parent's name:
(2) Parent's address:
(1) Parent's name:
(2) Parent's address:

g. Other caregiver, including Indian custodian (name, address, and relationship to child):

2. The child described in item 1

resides in this county.
was in this county at the time of the events alleged below.

PART II. APPLICANT'S AFFIDAVIT

3. My name and address:

Mother

Father

Other parent

Mother

Father

Other parent

4. My relationship to the child named in item 1 (specify):

5. The child named in item 1 is being abused or neglected, or is at risk of abuse or neglect, as described in Welfare and Institutions

Code section 300. I am applying for an investigation and commencement of proceedings in juvenile court.

6. Facts in support of application (describe what happened concisely, and include all known and relevant dates, times, names, and

addresses; use additional pages as needed, and label them as Attachment 6):

Continued on Attachment 6. Number of pages attached:

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

(TYPE OR PRINT NAME)

(SIGNATURE)

Form Approved for Optional Use
Judicial Council of California
JV-210 [Rev. January 1, 2023]

APPLICATION TO COMMENCE JUVENILE COURT PROCEEDINGS
AND DECISION OF SOCIAL WORKER
(Welfare & Institutions Code, § 329)

Page 1 of 2

Welfare and Institutions Code, § 329;
Probate Code, § 1513(b)
www.courts.ca.gov

a.
b.

Date:

CHILD'S NAME:

CASE NUMBER:

JV-210

PART III. PROBATE COURT REFERRAL

7. The Superior Court of

County, Department

, sitting as a probate court and assigned to determine a

petition for appointment of a guardian of the child named above in case number
the child named above is or may be described by Welfare and Institutions Code section 300. The court refers the child to the county
child welfare agency for an investigation to determine whether proceedings in juvenile court should be commenced.

, has determined that

8. The child is or may be described by Welfare and Institutions Code section 300 for the following reasons:

Continued on Attachment 8. Number of pages attached:

9. The following documents are attached to this form:

A copy of the Petition for Appointment of Guardian of Minor (form GC-210) or Petition for Appointment of Guardian of the
Person (form GC-210(P)) and all attachments filed in the probate guardianship proceeding identified above.

A copy of the investigator's report filed in the guardianship proceeding.

Other documents containing material information (name or brief description of each document or material):

(1)
(2)

(Name or description):
(Name or description):

DECISION OF SOCIAL WORKER OR CHILD WELFARE AGENCY

JUDICIAL OFFICER

11. After conducting the investigation required in response to the affidavit on page 1 or the referral above, I have decided:

a.
b.

to commence dependency proceedings by filing a petition in juvenile court.
not to commence dependency proceedings in juvenile court because (specify reasons, as well as any recommendation
made to the applicant):

Continued on Attachment 11b. Number of pages attached:

12.

The report of the findings and conclusions of my investigation is appended as Attachment 12.

I declare under penalty of perjury under the laws of the State of California that I am a social worker of the county in which this
application was submitted, I am authorized to determine whether to commence proceedings in the juvenile court, and the foregoing is
true and correct.

(TYPE OR PRINT NAME)

(SIGNATURE OF SOCIAL WORKER)

JV-210 [Rev. January 1, 2023]

Page 2 of 2

APPLICATION TO COMMENCE JUVENILE COURT PROCEEDINGS
AND DECISION OF SOCIAL WORKER
(Welfare & Institutions Code, § 329)

10. Social worker information:

a. Name:
b. Agency:
c. Address:
d. Telephone number:
e. Email address:

Date:

Application to Commence Proceedings by Affidavit and Decision by Social Worker (Welf. & Inst. Code, § 329)

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): 71
Average fields per page: 35
Reading Level: Grade 8
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_p_caption_ap_info_border_atty_party_bar was JV-210[0].Page1[0].P1Caption[0].APInfoBorder[0].AttyPartyInfo[0].AttyBarNo[0] (0.58 conf)
j_v_page_p_caption_ap_info_border_atty_party_name was JV-210[0].Page1[0].P1Caption[0].APInfoBorder[0].AttyPartyInfo[0].Name[0] (0.40 conf)
j_v_page_p_caption_ap_info_border_atty_party_firm was JV-210[0].Page1[0].P1Caption[0].APInfoBorder[0].AttyPartyInfo[0].AttyFirm[0] (0.42 conf)
j_v_page_p_caption_ap_info_border_atty_party_street was JV-210[0].Page1[0].P1Caption[0].APInfoBorder[0].AttyPartyInfo[0].Street[0] (0.40 conf)
j_v_page_p_caption_ap_info_border_atty_party_city was JV-210[0].Page1[0].P1Caption[0].APInfoBorder[0].AttyPartyInfo[0].City[0] (0.40 conf)
j_page_border_atty_party_state was JV-210[0].Page1[0].P1Caption[0].APInfoBorder[0].AttyPartyInfo[0].State[0] (0.40 conf)
j_v_page_p_caption_ap_info_border_atty_party_zip was JV-210[0].Page1[0].P1Caption[0].APInfoBorder[0].AttyPartyInfo[0].Zip[0] (0.40 conf)
j_v_page_p_caption_ap_info_border_atty_party_phone was JV-210[0].Page1[0].P1Caption[0].APInfoBorder[0].AttyPartyInfo[0].Phone[0] (0.40 conf)
j_v_page_p_caption_ap_info_border_atty_party_fax was JV-210[0].Page1[0].P1Caption[0].APInfoBorder[0].AttyPartyInfo[0].Fax[0] (0.40 conf)
j_v_page_p_caption_ap_info_border_atty_party_email was JV-210[0].Page1[0].P1Caption[0].APInfoBorder[0].AttyPartyInfo[0].Email[0] (0.40 conf)
j_v_page_p_caption_ap_info_border_atty_party was JV-210[0].Page1[0].P1Caption[0].APInfoBorder[0].AttyPartyInfo[0].AttyFor[0] (0.42 conf)
j_v_page_court_info_county was JV-210[0].Page1[0].P1Caption[0].CrtinfoBorder[0].CourtInfo[0].CrtCounty[0] (0.38 conf)
j_v_page_caption_court_street was JV-210[0].Page1[0].P1Caption[0].CrtinfoBorder[0].CourtInfo[0].CrtStreet[0] (0.38 conf)
j_v_page_caption_court_info was JV-210[0].Page1[0].P1Caption[0].CrtinfoBorder[0].CourtInfo[0].CrtMailingAdd[0] (0.38 conf)
j_v_page_p_caption_crtinfo_border_court_info_crt_city_zip was JV-210[0].Page1[0].P1Caption[0].CrtinfoBorder[0].CourtInfo[0].CrtCityZip[0] (0.39 conf)
j_v_page_court_info_branch was JV-210[0].Page1[0].P1Caption[0].CrtinfoBorder[0].CourtInfo[0].CrtBranch[0] (0.38 conf)
j_page_title_party_name_ft__1 was JV-210[0].Page1[0].P1Caption[0].TPNmBorder[0].TitlePartyName[0].Party1_ft[0] (0.35 conf)
j_page_p_case_num_number was JV-210[0].Page1[0].P1Caption[0].CaseNumBorder[0].CaseNumber[0].CaseNumber_ft[0] (0.40 conf)
j_v_page_item_childs_name_party_ft was JV-210[0].Page1[0].Item1[0].ChildsName[0].Party1_ft[0] (0.30 conf)
j_v_page_item_age_ft was JV-210[0].Page1[0].Item1[0].Age[0].Age_ft[0] (0.33 conf)
j_v_page_item_b_birth_dt was JV-210[0].Page1[0].Item1[0].DOB[0].DateofBirth_dt[0] (0.36 conf)
j_v_page_item_sex_ft was JV-210[0].Page1[0].Item1[0].Sex[0].Sex_ft[0] (0.35 conf)
j_page_parent_parents_name_ft__1 was JV-210[0].Page1[0].Item1[0].Parent1[0].ParentsName_ft1[0] (0.31 conf)
j_v_item_parent_mom_mother__1 was JV-210[0].Page1[0].Item1[0].Parent1[0].Mom1[0].mother_cb1[0] (0.32 conf)
j_v_item_parent_dad_father__1 was JV-210[0].Page1[0].Item1[0].Parent1[0].Dad1[0].father_cb1[0] (0.32 conf)
j_v_page_item_parent_cb__1 was JV-210[0].Page1[0].Item1[0].Parent1[0].Otherparent1[0].otherparent_cb1[0] (0.32 conf)
j_page_item_parent_add_ft__1 was JV-210[0].Page1[0].Item1[0].Parent1[0].ParentsAdd_ft1[0] (0.31 conf)
j_page_parent_parents_name_ft__2 was JV-210[0].Page1[0].Item1[0].Parent2[0].ParentsName_ft2[0] (0.31 conf)
j_v_item_parent_mom_mother__2 was JV-210[0].Page1[0].Item1[0].Parent2[0].Mom2[0].mother_cb2[0] (0.32 conf)
j_v_item_parent_dad_father__2 was JV-210[0].Page1[0].Item1[0].Parent2[0].Dad2[0].father_cb2[0] (0.32 conf)
j_v_page_item_parent_cb__2 was JV-210[0].Page1[0].Item1[0].Parent2[0].OtherParent2[0].otherparent_cb2[0] (0.35 conf)
j_page_item_parent_add_ft__2 was JV-210[0].Page1[0].Item1[0].Parent2[0].ParentsAdd_ft2[0] (0.31 conf)
j_v_page_item_caregiver_ft was JV-210[0].Page1[0].Item1[0].OtherCaregiver[0].OtherCaregiver_ft[0] (0.32 conf)
j_v_page_item_child_res_cb was JV-210[0].Page1[0].Item2[0].ChildResHere[0].ChildRes_cb[0] (0.36 conf)
j_v_page_item_child_event_cb was JV-210[0].Page1[0].Item2[0].ChildEventHere[0].ChildHere_cb[0] (0.31 conf)
j_v_page_item_nm_add_ft was JV-210[0].Page1[0].Item3[0].ApplNmAdd_ft[0] (0.40 conf)
j_v_page_item_relto_child_ft was JV-210[0].Page1[0].Item4[0].ReltoChild_ft[0] (0.30 conf)
j_v_page_item_supporting_facts was JV-210[0].Page1[0].Item6[0].SupportingFacts_ft[0] (0.35 conf)
j_v_page_item_att_cb__1 was JV-210[0].Page1[0].Item6[0].Att6_cb[0] (0.30 conf)
j_v_page_item_numpp_att_ft was JV-210[0].Page1[0].Item6[0].NumppAtt_ft[0] (0.35 conf)
j_v_page_sig_applicant_date was JV-210[0].Page1[0].SigApplicant[0].Date[0] (0.31 conf)
j_page_sig_applicant_print_name was JV-210[0].Page1[0].SigApplicant[0].PrintName[0] (0.33 conf)
j_page_title_party_name_ft__2 was JV-210[0].Page2[0].CaptionSub[0].TitlePartyName[0].Party1_ft[0] (0.33 conf)
j_v_page_case_number_ft was JV-210[0].Page2[0].CaptionSub[0].CaseNumBorder[0].CaseNumber[0].CaseNumber_ft[0] (0.37 conf)
j_v_item_cty_sup_ct_ft was JV-210[0].Page2[0].Item7[0].CtySupCt_ft[0] (0.34 conf)
j_v_page_item_dept_ft was JV-210[0].Page2[0].Item7[0].Dept_ft[0] (0.39 conf)
j_v_page_item_case_num_ft was JV-210[0].Page2[0].Item7[0].GdnshpCaseNum_ft[0] (0.32 conf)
j_v_page_item_child_ft was JV-210[0].Page2[0].Item8[0].WhyChild300_ft[0] (0.32 conf)
j_v_page_item_att_cb__2 was JV-210[0].Page2[0].Item8[0].Att8_cb[0] (0.30 conf)
j_v_page_item_nm_pp_att_ft was JV-210[0].Page2[0].Item8[0].NmPPAtt8_ft[0] (0.38 conf)
j_v_page_item_ptn_att_cb was JV-210[0].Page2[0].Item9[0].Item9aPtnAtt[0].PtnAtt_cb[0] (0.38 conf)
j_v_item_b_rpt_att_cb was JV-210[0].Page2[0].Item9[0].Item9b[0].GdnshpInvRptAtt[0].GdnshpInvRep_cb[0] (0.39 conf)
j_v_page_item_c_docs_cb was JV-210[0].Page2[0].Item9[0].Item9c[0].OtherDocs_cb[0] (0.37 conf)
j_v_page_item_c_doc_cb__1 was JV-210[0].Page2[0].Item9[0].Item9c[0].Item9c1[0].Doc9c1_cb[0] (0.32 conf)
j_v_page_item_c_doc_ft__1 was JV-210[0].Page2[0].Item9[0].Item9c[0].Item9c1[0].Doc9c1_ft[0] (0.32 conf)
j_v_page_item_c_doc_cb__2 was JV-210[0].Page2[0].Item9[0].Item9c[0].Item9c2[0].Doc9c2_cb[0] (0.32 conf)
j_v_page_item_c_doc_ft__2 was JV-210[0].Page2[0].Item9[0].Item9c[0].Item9c2[0].Doc9c2_ft[0] (0.32 conf)
j_v_page_item_sw_name_ft was JV-210[0].Page2[0].Item10[0].SWName_ft[0] (0.32 conf)
j_v_page_item_sw_agency_ft was JV-210[0].Page2[0].Item10[0].SWAgency_ft[0] (0.38 conf)
j_v_page_item_sw_address_ft was JV-210[0].Page2[0].Item10[0].SWAddress_ft[0] (0.31 conf)
j_v_page_item_sw_phone_ft was JV-210[0].Page2[0].Item10[0].SWPhone_ft[0] (0.37 conf)
j_v_page_item_sw_email_ft was JV-210[0].Page2[0].Item10[0].SWEmail_ft[0] (0.36 conf)
j_v_page_item_yes_dep_cb was JV-210[0].Page2[0].Item11[0].YesDepPtn_cb[0] (0.39 conf)
j_v_page_item_dep_ptn_cb__1 was JV-210[0].Page2[0].Item11[0].NoDepPtn_cb[0] (0.39 conf)
j_v_page_item_dep_ptn_cb__2 was JV-210[0].Page2[0].Item11[0].WhyNoDepPtn_cb[0] (0.40 conf)
j_v_page_item_att_b_cb was JV-210[0].Page2[0].Item11[0].Att11b_cb[0] (0.30 conf)
j_v_page_item_num_att_ft was JV-210[0].Page2[0].Item11[0].NumPPAtt_ft[0] (0.34 conf)
j_v_page_item_rpt_att_cb was JV-210[0].Page2[0].Item12[0].RptAtt12_cb[0] (0.30 conf)
j_v_page_sig_block_w_date was JV-210[0].Page2[0].SigBlockSW[0].DateSigSW[0] (0.35 conf)
j_page_sig_block_w_print_name was JV-210[0].Page2[0].SigBlockSW[0].PrintSWName[0] (0.33 conf)
j_v_page_sig_block_prob_dt was JV-210[0].Page2[0].SigBlockProbJO[0].SigDate_dt[0] (0.33 conf)

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

Suggested Screen 0:

j_v_page_p_caption_ap_info_border_atty_party_bar
j_v_page_p_caption_ap_info_border_atty_party_name
j_v_page_p_caption_ap_info_border_atty_party_firm
j_v_page_p_caption_ap_info_border_atty_party_street
j_v_page_p_caption_ap_info_border_atty_party_city
j_page_border_atty_party_state
j_v_page_p_caption_ap_info_border_atty_party_zip
j_v_page_p_caption_ap_info_border_atty_party_phone
j_v_page_p_caption_ap_info_border_atty_party_fax
j_v_page_p_caption_ap_info_border_atty_party_email
j_v_page_p_caption_ap_info_border_atty_party
j_v_page_p_caption_crtinfo_border_court_info_crt_city_zip

Suggested Screen 1:

j_v_page_court_info_county
j_v_page_caption_court_street
j_v_page_caption_court_info
j_v_page_court_info_branch

Suggested Screen 2:

j_page_title_party_name_ft__1
j_page_parent_parents_name_ft__1
j_page_item_parent_add_ft__1
j_page_parent_parents_name_ft__2
j_page_item_parent_add_ft__2
j_page_sig_applicant_print_name
j_page_title_party_name_ft__2

Suggested Screen 3:

j_page_p_case_num_number

Suggested Screen 4:

j_v_item_parent_mom_mother__1
j_v_item_parent_dad_father__1
j_v_item_parent_mom_mother__2
j_v_item_parent_dad_father__2

Suggested Screen 5:

j_v_page_item_childs_name_party_ft
j_v_page_item_age_ft
j_v_page_item_sex_ft
j_v_page_item_caregiver_ft
j_v_page_item_child_event_cb
j_v_page_item_relto_child_ft
j_v_page_item_supporting_facts
j_v_page_case_number_ft
j_v_page_item_dept_ft
j_v_page_item_child_ft

Suggested Screen 6:

j_v_page_item_parent_cb__1
j_v_page_item_parent_cb__2
j_v_page_item_child_res_cb
j_v_page_item_att_cb__1
j_v_page_item_att_cb__2
j_v_page_item_nm_pp_att_ft
j_v_page_item_ptn_att_cb
j_v_item_b_rpt_att_cb
j_v_page_item_dep_ptn_cb__1
j_v_page_item_dep_ptn_cb__2
j_v_page_item_att_b_cb
j_v_page_item_rpt_att_cb

Suggested Screen 7:

j_v_item_cty_sup_ct_ft

Suggested Screen 8:

j_v_page_item_b_birth_dt
j_v_page_item_c_docs_cb
j_v_page_item_c_doc_cb__1
j_v_page_item_c_doc_ft__1
j_v_page_item_c_doc_cb__2
j_v_page_item_c_doc_ft__2

Suggested Screen 9:

j_v_page_item_nm_add_ft
j_v_page_item_numpp_att_ft
j_v_page_item_case_num_ft
j_v_page_item_sw_name_ft
j_v_page_item_sw_agency_ft
j_v_page_item_sw_address_ft
j_v_page_item_sw_phone_ft
j_v_page_item_sw_email_ft
j_v_page_item_yes_dep_cb
j_v_page_item_num_att_ft

Suggested Screen 10:

j_v_page_sig_applicant_date
j_v_page_sig_block_w_date
j_page_sig_block_w_print_name
j_v_page_sig_block_prob_dt

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

Application to Commence Proceedings by Affidavit and Decision by Social Worker (Welf. & Inst. Code, § 329)

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

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