JV-555

Notice of Intent to Place Child Out 
of County

Clerk stamps date here when form is filed.

This notice must be served with a blank copy of form JV-556, Objection to Out-
of-County Placement and Notice of Hearing, and must be provided 14 days 
before the proposed date of placement. If the child is moving from a temporary 
care facility, this notice must be provided immediately after oral notice.

1 To:

a.

Parent or guardian (name):

b.

Parent or guardian (name):

c. Parent’s attorney, if any (name):

d. Parent’s attorney, if any (name):

e. Child’s attorney (name):

Fill in court name and street address:

Superior Court of California, County of

Fill in child's name and date of birth:

Child's Name:

Date of Birth:

Court fills in case number when form is filed.

g. Child’s identified Indian tribe, if any (name):

Case Number:

f. Child, if 10 years of age or older (name):

h. Child’s Indian custodian, if any (name):

i. Child’s Court Appointed Special Advocate (CASA) program, if any (name of person notified):

2

Name of agency proposing move:

Address:

Phone number:

The agency intends to place the child out of county. The reasons why placement must be outside of the county are:

If you need more space, attach a sheet of paper and write “JV-555, Item 2—Reasons for Out-of-County Placement” 
at the top.

Number of pages attached:

Judicial Council of California,  www.courts.ca.gov  
Rev. January 1, 2020, Optional Form  
Welfare and Institutions Code, § 361.2(h)  
California Rules of Court, rule 5.614

Notice of Intent to Place Child 
Out of County

JV-555, Page 1 of 2

Child’s name:

Case Number:

3

If you do not agree with the out-of-county placement, you may request a court hearing. To do so, you can fill 
out form JV-556, Objection to Out-of-County Placement and Notice of Hearing, and file it with the court within 
seven days after the date you received this notice, or seven days after you received oral notice that the child was 
moving from a temporary shelter facility.

I declare under penalty of perjury under the laws of the State of California that the information in items 1 and 2 is true and 
correct, which means that if I lie on the form, I am committing a crime.

Date:

Type or print your name

Sign your name

Rev. January 1, 2020

JV-555, Page 2 of 2

Notice of Intent to Place Child 
Out of County