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

LIT Lab Home | About The Explorer | Find & Compare | Explore: California Lists

Here is the text we could read:

1

2

3

4

5

JV-221

Proof of Notice of Application

Clerk stamps date here when form is filed.

Read form JV-217-INFO, Guide to Psychotropic Medication Forms, for  more 
information about the required forms and the application process.

The following parents/legal guardians of the child were notified  
of the physician’s request to begin and/or to continue administering  
psychotropic medication, of the name of each medication, and that an 
application is pending before the court. They were also provided with 
form JV-217-INFO, Guide to Psychotropic Medication Forms, a 
blank copy of form JV-219, Statement About Medicine Prescribed and 
a blank copy of form JV-222, Input on Application for Psychotropic 
Medication. 

a. Name: 

Relationship to child:

Date notified:

Manner: 

In person

By phone at (specify):

Fill in court name and street address:

Superior Court of California, County of

By depositing the required information in a sealed envelope in 
the United States mail, with first-class postage prepaid, to the 
last known address (specify):

Fill in child's name and date of birth:

Child's Name:

Date of Birth:

Case Number:

b. Name: 

Date notified:

Court fills in case number when form is filed.

Relationship to child:

Manner: 

In person

By phone at (specify):

By depositing the required information in a sealed envelope in the United States mail, with first-class 
postage prepaid, to the last known address (specify):

c. Name: 

Date notified:

Relationship to child:

Manner: 

In person

By phone at (specify):

By depositing the required information in a sealed envelope in the United States mail, with first-class 
postage prepaid, to the last known address (specify):

Parental rights were terminated, and the child has no legal parents who must be informed.

Parent/legal guardian (name):
was not informed because (state reason):

Parent/legal guardian (name):
was not informed because (state reason):

The child’s current caregiver was notified that a physician is asking to treat the child with psychotropic 
medication and that an application is pending before the court. The caregiver was provided form JV-217-INFO, 
Guide to Psychotropic Medication Forms and a blank copy of form JV-219, Statement About Medicine 
Prescribed, or information on how to obtain a copy of the form as follows:

Judicial Council of California,  
Rev. January 1, 2021, Mandatory Form 
Welfare and Institutions Code, § 369.5  
California Rules of Court, rule 5.640 and 5.642

Proof of Notice of Application 

JV-221, Page 1 of 4

Child’s name:

(specify):

Date:

6

Type or print name

Case Number:

Date notified:

Date notified:

Date notified:

Date notified:

Date notified:

Caregiver’s name: 
Manner: 

In person

By phone at (specify):

By depositing the required information in a sealed envelope in the United States mail, with first-class postage 
prepaid, to the following address

At the time of service I was at least 18 years of age and not a party to this matter. I am a resident of or employed in the 
 county where the mailing occurred. My residence or business mailing address is: 

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

Sign your name

Signature follows on page 4.

The child’s attorney and the child’s CAPTA guardian ad litem, if that person is someone other than the child’s  
attorney, were provided with completed form JV-220, Application for Psychotropic Medication; completed 
JV-220(A), Physician’s Statement—Attachment or completed form JV-220(B), Physician's Request to Continue 
Medication—Attachment; a copy of form JV-217-INFO, Guide to Psychotropic Medication Forms; a blank form 
JV-218, Child's Opinion About the Medication; and a blank copy of form JV-222, Input on Application for 
Psychotropic Medication, as follows:

By depositing copies in a sealed envelope in the United States mail, with first-class postage prepaid,

a. Attorney’s name: 

Manner: 

In person

By fax at (specify):

to the last known address (specify):
b. CAPTA guardian ad litem’s name: 

Manner: 

In person

By fax at (specify):

By depositing copies in a sealed envelope in the United States mail, with first-class postage prepaid,

to the last known address (specify):

7

The application could result in the child being prescribed three or more concurrent psychotropic medications for 
90 days or more. The child’s attorney and the child’s CAPTA guardian ad litem, if that person is someone other 
than the child’s attorney, were provided with blank copies of Position on Release of Information to Medical 
Board of California (form JV-228), Background on Release of Information to Medical Board of California 
(form JV-228-INFO), and Withdrawal of Release of Information to Medical Board of California (form JV-229), 
as follows:

By depositing copies in a sealed envelope in the United States mail, with first-class postage prepaid,

a. Attorney’s name: 

Manner: 

In person

By fax at (specify):

to the last known address (specify):
b. CAPTA guardian ad litem’s name: 

Manner: 

In person

By fax at (specify):

By depositing copies in a sealed envelope in the United States mail, with first-class postage prepaid,

to the last known address (specify):

Rev. January 1, 2021

Proof of Notice of Application 

JV-221, Page 2 of 4

Child’s name:

8

The following attorneys were notified of the physician’s request to begin and/or continue administering 
psychotropic medication, of the name of each medication, and that an application is pending before the court. 
They were also provided with a copy of form JV-217-INFO, Guide to Psychotropic Medication Forms, a blank 
copy of form JV-219, Statement About Medicine Prescribed; and a blank copy of form JV-222, Input on 
Application for Psychotropic Medication, or with information on how to obtain a copy of each form as follows: 

By phone at (specify):

By fax at (specify):

By depositing the required information and copies of forms JV-217-INFO and JV-222 in a sealed envelope 
in the United States mail, with first-class postage prepaid, to the last known address (specify):

By phone at (specify):

By fax at

(specify):

By depositing the required information and copies of forms JV-217-INFO and JV-222 in a sealed envelope 
in the United States mail, with first-class postage prepaid, to the last known address (specify):

a. Attorney’s name: 

Attorney for (name): 
In person
Manner: 

b. Attorney’s name: 

Attorney for (name): 
In person
Manner: 

c. Attorney’s name: 

Attorney for (name): 
In person
Manner: 

Case Number:

Date notified:

Date notified:

Date notified:

By phone at(specify):

By fax at (specify):

By depositing the required information and copies of forms JV-217-INFO and JV-222 in a sealed envelope 
in the United States mail, with first-class postage prepaid, to the last known address (specify):

At the time of service I was at least 18 years of age and not a party to this matter. I am a resident of or employed in the 
 county where the mailing occurred. My residence or business mailing address is: 

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

Sign your name

Signature follows on page 4.

Type or print name

9

The child’s CASA volunteer was notified of the physician's request to begin and/or continue administering 
psychotropic medication, of the name of each medication, and that an application is pending before the court. 
The CASA volunteer was provided with form JV-217-INFO, Guide to Psychotropic Medication Forms; a blank 
copy of form JV-218, Child's Opinion About the Medicine; and a blank copy of form JV-219, Statement About 
Medicine Prescribed, as follows:

CASA volunteer (name):
Manner: 

In person

By phone at (specify):

Date notified:

By depositing the required information in a sealed envelope in the United States mail, with first-class postage 
prepaid, to the last known address (specify):

Rev. January 1, 2021

Proof of Notice of Application 

JV-221, Page 3 of 4

Case Number:

Child’s name:

10

The Indian child’s tribe was notified of the physician’s request to begin and/or continue administering 
psychotropic medication, of the name of each medication, and that an application is pending before the court. 
The tribe was also provided with form JV-217-INFO, Guide to Psychotropic Medication Forms, a blank copy of 
form JV-219, Statement About Medicine Prescribed, and a blank copy of form JV-222, Input on Application for 
Psychotropic Medication. 

Indian Tribe (name):
Manner: 

In person

By phone at (specify):

Date notified:
By fax at (specify):

By depositing the required information in a sealed envelope in the United States mail, with first-class postage 
prepaid, to the last known address (specify):

At the time of service I was at least 18 years of age and not a party to this matter. I am a resident of or employed in the  
county where the mailing occurred. My residence or business mailing address is:  

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

Date:

Type or print name

Sign your name

Rev. January 1, 2021

Proof of Notice of Application 

JV-221, Page 4 of 4

Proof of Notice of Application

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): 4
Fields(s): 141
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_sub_court_info_ft was JV-221[0].Page1[0].Page1Sub[0].CourtInfoSub[0].CourtInfo_ft[0] (0.54 conf)
j_page_sub_court_name_ft was JV-221[0].Page1[0].Page1Sub[0].CourtInfoSub[0].ChildsName_ft[0] (0.34 conf)
j_v_page_court_info_date was JV-221[0].Page1[0].Page1Sub[0].CourtInfoSub[0].DateField1[0] (0.38 conf)
j_page_court_case_number_ft was JV-221[0].Page1[0].Page1Sub[0].CourtInfoSub[0].CaseNumber_ft[0] (0.40 conf)
j_v_page_sub_list_item_cb was JV-221[0].Page1[0].Page1Sub[0].List1[0].Item1_cb[0] (0.35 conf)
j_v_page_sub_list_l_item__1 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI1[0].item1aname_tf[0] (0.33 conf)
j_v_page_sub_list_l_item__2 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI1[0].item1adate_df[0] (0.33 conf)
j_v_sub_list_l_item__1 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI1[0].item1arelationship_tf[0] (0.33 conf)
j_v_sub_list_l_item__2 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI1[0].item1ainperson_cb[0] (0.33 conf)
j_v_sub_list_l_item_cb__1 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI1[0].item1abyphone_cb[0] (0.33 conf)
j_v_page_sub_list_l_item__3 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI1[0].item1aspecify_tf[0] (0.33 conf)
j_v_sub_list_l_item__3 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI1[0].item1aknownaddress_cb[0] (0.33 conf)
j_v_sub_list_l_item__4 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI1[0].item1aknownaddress_tf[0] (0.33 conf)
j_v_page_sub_list_l_item__4 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI2[0].item1bname_tf[0] (0.33 conf)
j_v_page_sub_list_l_item__5 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI2[0].item1bdate_df[0] (0.33 conf)
j_v_sub_list_l_item__5 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI2[0].item1brelationship_tf[0] (0.33 conf)
j_v_sub_list_l_item__6 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI2[0].item1binperson_cb[0] (0.33 conf)
j_v_sub_list_l_item_cb__2 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI2[0].item1bbyphone_cb[0] (0.33 conf)
j_v_page_sub_list_l_item__6 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI2[0].item1bspecify_tf[0] (0.33 conf)
j_v_sub_list_l_item__7 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI2[0].item1bknownaddress_cb[0] (0.33 conf)
j_v_sub_list_l_item__8 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI2[0].item1bknownaddress_tf[0] (0.33 conf)
j_v_page_sub_list_l_item__7 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI3[0].item1cname_tf[0] (0.33 conf)
j_v_page_list_l_item__1 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI3[0].item1cdatenotified_df[0] (0.33 conf)
j_v_sub_list_l_item__9 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI3[0].item1crelationship_tf[0] (0.33 conf)
j_v_sub_list_l_item__10 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI3[0].item1cinperson_cb[0] (0.33 conf)
j_v_sub_list_l_item_cb__3 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI3[0].item1cbyphone_cb[0] (0.33 conf)
j_v_page_sub_list_l_item__8 was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI3[0].item1cspecify_tf[0] (0.33 conf)
j_sub_list_l_check_box was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI3[0].MultilineCheckBox_cb[0] (0.36 conf)
j_v_page_sub_list_l_specify was JV-221[0].Page1[0].Page1Sub[0].List1[0].LI3[0].OtherSpecify_tf[0] (0.34 conf)
j_v_sub_list_l_item_cb__4 was JV-221[0].Page1[0].Page1Sub[0].List2[0].LI1[0].Item2_cb[0] (0.33 conf)
j_v_page_list_l_item_tx__1 was JV-221[0].Page1[0].Page1Sub[0].List3[0].LI1[0].Item3_tx[0] (0.33 conf)
j_v_page_sub_list_l_field__1 was JV-221[0].Page1[0].Page1Sub[0].List3[0].LI1[0].TextField1[0] (0.33 conf)
j_v_page_sub_list_l_field__2 was JV-221[0].Page1[0].Page1Sub[0].List3[0].LI1[0].TextField2[0] (0.33 conf)
j_v_sub_list_l_item_cb__5 was JV-221[0].Page1[0].Page1Sub[0].List4[0].LI1[0].item4_cb[0] (0.33 conf)
j_v_sub_list_l_item_name was JV-221[0].Page1[0].Page1Sub[0].List4[0].LI1[0].item4name_tf[0] (0.33 conf)
j_v_sub_list_l_item_reason was JV-221[0].Page1[0].Page1Sub[0].List4[0].LI1[0].item4reason_tf[0] (0.33 conf)
j_v_page_list_l_item_tx__2 was JV-221[0].Page1[0].Page1Sub[0].List5[0].LI1[0].Item3_tx[0] (0.33 conf)
j_v_page_case_number_ft__1 was JV-221[0].Page2[0].HeaderSub[0].CaseNumber_ft[0] (0.33 conf)
j_v_page_header_sub_childs_name_ft__1 was JV-221[0].Page2[0].HeaderSub[0].ChildsName_ft[0] (0.29 conf)
j_v_list_l_item_caregiver was JV-221[0].Page2[0].List5[0].LI1[0].item5caregiver_tf[0] (0.31 conf)
j_v_page_list_l_item_date__1 was JV-221[0].Page2[0].List5[0].LI1[0].item5date_df[0] (0.31 conf)
j_v_page_list_l_item_cb__1 was JV-221[0].Page2[0].List5[0].LI1[0].item5inperson_cb[0] (0.31 conf)
j_v_page_list_l_item_cb__2 was JV-221[0].Page2[0].List5[0].LI1[0].item5byphone_cb[0] (0.31 conf)
j_v_page_list_l_item_specify was JV-221[0].Page2[0].List5[0].LI1[0].item5specify_tf[0] (0.31 conf)
j_v_page_list_l_item_cb__3 was JV-221[0].Page2[0].List5[0].LI1[0].item5reqinfo_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__1 was JV-221[0].Page2[0].List5[0].LI1[0].item5reqinfo_tf[0] (0.31 conf)
j_v_page_sign_sub_item_adate__1 was JV-221[0].Page2[0].SignSub[0].item6adate_df[0] (0.30 conf)
j_page_sign_date_name_item was JV-221[0].Page2[0].SignSub[0].DateName_gp[0].item5signdate_df[0] (0.32 conf)
j_sign_date_name_item_ft was JV-221[0].Page2[0].SignSub[0].DateName_gp[0].item5typename_ft[0] (0.32 conf)
j_v_sign_sub_item_cb was JV-221[0].Page2[0].SignSub[0].item5signature_cb[0] (0.30 conf)
j_v_page_list_item_cb__1 was JV-221[0].Page2[0].List6[0].item6_cb[0] (0.32 conf)
j_v_page_list_l_item__2 was JV-221[0].Page2[0].List6[0].LI1[0].item6aattyname_tf[0] (0.31 conf)
j_v_page_list_l_item_adate__1 was JV-221[0].Page2[0].List6[0].LI1[0].item6adate_df[0] (0.31 conf)
j_v_page_list_l_item__3 was JV-221[0].Page2[0].List6[0].LI1[0].item6ainperson_cb[0] (0.31 conf)
j_v_page_list_l_item_cb__4 was JV-221[0].Page2[0].List6[0].LI1[0].item6afax_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__2 was JV-221[0].Page2[0].List6[0].LI1[0].item6aspecify_tf[0] (0.31 conf)
j_v_page_list_l_item_cb__5 was JV-221[0].Page2[0].List6[0].LI1[0].item6aprepaid_cb[0] (0.31 conf)
j_v_page_list_l_item__4 was JV-221[0].Page2[0].List6[0].LI1[0].item6aknownaddress_tf[0] (0.31 conf)
j_v_page_list_l_item_tf__3 was JV-221[0].Page2[0].List6[0].LI2[0].item6bname_tf[0] (0.31 conf)
j_v_page_list_l_item_bdate__1 was JV-221[0].Page2[0].List6[0].LI2[0].item6bdate_df[0] (0.31 conf)
j_v_page_list_l_item__5 was JV-221[0].Page2[0].List6[0].LI2[0].item6binperson_cb[0] (0.31 conf)
j_v_page_list_l_item_cb__6 was JV-221[0].Page2[0].List6[0].LI2[0].item6bfax_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__4 was JV-221[0].Page2[0].List6[0].LI2[0].item6bspecify_tf[0] (0.31 conf)
j_v_page_list_l_item_cb__7 was JV-221[0].Page2[0].List6[0].LI2[0].item6bprepaid_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__5 was JV-221[0].Page2[0].List6[0].LI2[0].item6baddress_tf[0] (0.31 conf)
j_v_page_list_item_cb__2 was JV-221[0].Page2[0].List7[0].item6_cb[0] (0.32 conf)
j_v_page_list_l_item__6 was JV-221[0].Page2[0].List7[0].LI1[0].item6aattyname_tf[0] (0.31 conf)
j_v_page_list_l_item_adate__2 was JV-221[0].Page2[0].List7[0].LI1[0].item6adate_df[0] (0.31 conf)
j_v_page_list_l_item__7 was JV-221[0].Page2[0].List7[0].LI1[0].item6ainperson_cb[0] (0.31 conf)
j_v_page_list_l_item_cb__8 was JV-221[0].Page2[0].List7[0].LI1[0].item6afax_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__6 was JV-221[0].Page2[0].List7[0].LI1[0].item6aspecify_tf[0] (0.31 conf)
j_v_page_list_l_item_cb__9 was JV-221[0].Page2[0].List7[0].LI1[0].item6aprepaid_cb[0] (0.31 conf)
j_v_page_list_l_item__8 was JV-221[0].Page2[0].List7[0].LI1[0].item6aknownaddress_tf[0] (0.31 conf)
j_v_page_list_l_item_tf__7 was JV-221[0].Page2[0].List7[0].LI2[0].item6bname_tf[0] (0.31 conf)
j_v_page_list_l_item_bdate__2 was JV-221[0].Page2[0].List7[0].LI2[0].item6bdate_df[0] (0.31 conf)
j_v_page_list_l_item__9 was JV-221[0].Page2[0].List7[0].LI2[0].item6binperson_cb[0] (0.31 conf)
j_v_page_list_l_item_cb__10 was JV-221[0].Page2[0].List7[0].LI2[0].item6bfax_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__8 was JV-221[0].Page2[0].List7[0].LI2[0].item6bspecify_tf[0] (0.31 conf)
j_v_page_list_l_item_cb__11 was JV-221[0].Page2[0].List7[0].LI2[0].item6bprepaid_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__9 was JV-221[0].Page2[0].List7[0].LI2[0].item6baddress_tf[0] (0.31 conf)
j_v_page_case_number_ft__2 was JV-221[0].Page3[0].HeaderSub[0].CaseNumber_ft[0] (0.33 conf)
j_v_page_header_sub_childs_name_ft__2 was JV-221[0].Page3[0].HeaderSub[0].ChildsName_ft[0] (0.29 conf)
j_v_page_list_item_cb__3 was JV-221[0].Page3[0].List8[0].item7_cb[0] (0.32 conf)
j_v_page_list_l_item__10 was JV-221[0].Page3[0].List8[0].LI1[0].item7aattyname_tf[0] (0.31 conf)
j_v_page_list_l_item_adate__3 was JV-221[0].Page3[0].List8[0].LI1[0].item7adate_df[0] (0.31 conf)
j_v_page_list_l_item_tf__10 was JV-221[0].Page3[0].List8[0].LI1[0].item7aatty_tf[0] (0.31 conf)
j_v_page_list_l_item__11 was JV-221[0].Page3[0].List8[0].LI1[0].item7ainperson_cb[0] (0.31 conf)
j_v_page_list_l_item_cb__12 was JV-221[0].Page3[0].List8[0].LI1[0].item7abyphone_cb[0] (0.31 conf)
j_v_page_list_l_item__12 was JV-221[0].Page3[0].List8[0].LI1[0].item7aphonenum_tf[0] (0.31 conf)
j_v_page_list_l_item_cb__13 was JV-221[0].Page3[0].List8[0].LI1[0].item7afax_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__11 was JV-221[0].Page3[0].List8[0].LI1[0].item7afaxnum_tf[0] (0.31 conf)
j_v_page_list_l_item__13 was JV-221[0].Page3[0].List8[0].LI1[0].item7aknownaddress_cb[0] (0.31 conf)
j_v_page_list_l_item__14 was JV-221[0].Page3[0].List8[0].LI1[0].item7cknownaddress_tf[0] (0.31 conf)
j_v_page_list_l_item__15 was JV-221[0].Page3[0].List8[0].LI2[0].item7battyname_tf[0] (0.31 conf)
j_v_page_list_l_item_bdate__3 was JV-221[0].Page3[0].List8[0].LI2[0].item7bdate-df[0] (0.31 conf)
j_v_page_list_l_item_tf__12 was JV-221[0].Page3[0].List8[0].LI2[0].item7batty_tf[0] (0.31 conf)
j_v_page_list_l_item__16 was JV-221[0].Page3[0].List8[0].LI2[0].item7binperson_cb[0] (0.31 conf)
j_v_page_list_l_item_cb__14 was JV-221[0].Page3[0].List8[0].LI2[0].item7bbyphone_cb[0] (0.31 conf)
j_v_page_list_l_item__17 was JV-221[0].Page3[0].List8[0].LI2[0].item7bphonenumb_tf[0] (0.31 conf)
j_v_page_list_l_item_cb__15 was JV-221[0].Page3[0].List8[0].LI2[0].item7bbyfax_cb[0] (0.31 conf)
j_v_page_list_l_item_ft was JV-221[0].Page3[0].List8[0].LI2[0].item7bfaxnum_ft[0] (0.31 conf)
j_v_page_list_l_item__18 was JV-221[0].Page3[0].List8[0].LI2[0].item7bknownaddress_cb[0] (0.31 conf)
j_v_page_list_l_item__19 was JV-221[0].Page3[0].List8[0].LI2[0].item7cknownaddress_tf[0] (0.31 conf)
j_v_page_list_l_item__20 was JV-221[0].Page3[0].List8[0].LI3[0].item7cattyname_tf[0] (0.31 conf)
j_v_page_list_l_item_cdate was JV-221[0].Page3[0].List8[0].LI3[0].item7cdate_df[0] (0.31 conf)
j_v_page_list_l_item_tf__13 was JV-221[0].Page3[0].List8[0].LI3[0].item7cattyfor_tf[0] (0.31 conf)
j_v_page_list_l_item__21 was JV-221[0].Page3[0].List8[0].LI3[0].item7cinperson_cb[0] (0.31 conf)
j_v_page_list_l_item_cb__16 was JV-221[0].Page3[0].List8[0].LI3[0].item7cbyphone_cb[0] (0.31 conf)
j_v_page_list_l_item__22 was JV-221[0].Page3[0].List8[0].LI3[0].item7cphonenum_tf[0] (0.31 conf)
j_v_page_list_l_item_cb__17 was JV-221[0].Page3[0].List8[0].LI3[0].item7cfax_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__14 was JV-221[0].Page3[0].List8[0].LI3[0].item7cfaxnum_tf[0] (0.31 conf)
j_v_page_list_l_item__23 was JV-221[0].Page3[0].List8[0].LI3[0].item7cknownaddress_cb[0] (0.31 conf)
j_v_page_list_l_item__24 was JV-221[0].Page3[0].List8[0].LI3[0].item7cknownaddress_tf[0] (0.31 conf)
j_v_page_sign_sub_item_adate__2 was JV-221[0].Page3[0].SignSub[0].item6adate_df[0] (0.30 conf)
j_page_sign_date_time_field__1 was JV-221[0].Page3[0].SignSub[0].DateTimeField1[0] (0.34 conf)
j_v_page_sign_sub_name_ft__1 was JV-221[0].Page3[0].SignSub[0].YourName_ft[0] (0.40 conf)
j_v_page_sign_sub_name_cb was JV-221[0].Page3[0].SignSub[0].FieldName_cb[0] (0.41 conf)
j_v_page_list_l_item_cb__18 was JV-221[0].Page3[0].List9[0].LI1[0].item8_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__15 was JV-221[0].Page3[0].List9[0].LI1[0].item8casaname_tf[0] (0.31 conf)
j_v_page_list_l_item_date__2 was JV-221[0].Page3[0].List9[0].LI1[0].item8date_df[0] (0.31 conf)
j_v_page_list_l_item_cb__19 was JV-221[0].Page3[0].List9[0].LI1[0].item8inperson_cb[0] (0.31 conf)
j_v_page_list_l_item_cb__20 was JV-221[0].Page3[0].List9[0].LI1[0].item8byphone_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__16 was JV-221[0].Page3[0].List9[0].LI1[0].item8phonenum_tf[0] (0.31 conf)
j_v_page_list_l_item__25 was JV-221[0].Page3[0].List9[0].LI1[0].item8knownadress_cb[0] (0.31 conf)
j_v_page_list_l_item__26 was JV-221[0].Page3[0].List9[0].LI1[0].item8knownaddress1_tf[0] (0.31 conf)
j_v_page_list_l_item__27 was JV-221[0].Page3[0].List9[0].LI1[0].item8knownaddress2_tf[0] (0.31 conf)
j_v_page_case_number_ft__3 was JV-221[0].Page4[0].HeaderSub[0].CaseNumber_ft[0] (0.33 conf)
j_v_page_header_sub_childs_name_ft__3 was JV-221[0].Page4[0].HeaderSub[0].ChildsName_ft[0] (0.29 conf)
j_v_page_list_l_item_cb__21 was JV-221[0].Page4[0].List10[0].LI1[0].item9_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__17 was JV-221[0].Page4[0].List10[0].LI1[0].item9indtribe_tf[0] (0.31 conf)
j_v_list_l_item_date_tf was JV-221[0].Page4[0].List10[0].LI1[0].item9date_tf[0] (0.31 conf)
j_v_page_list_l_item_cb__22 was JV-221[0].Page4[0].List10[0].LI1[0].item9inperson_cb[0] (0.31 conf)
j_v_page_list_l_item_cb__23 was JV-221[0].Page4[0].List10[0].LI1[0].item9byphone_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__18 was JV-221[0].Page4[0].List10[0].LI1[0].item9phonenum_tf[0] (0.31 conf)
j_v_page_list_l_item_cb__24 was JV-221[0].Page4[0].List10[0].LI1[0].item9fax_cb[0] (0.31 conf)
j_v_page_list_l_item_tf__19 was JV-221[0].Page4[0].List10[0].LI1[0].item9faxnum_tf[0] (0.31 conf)
j_v_page_list_l_item__28 was JV-221[0].Page4[0].List10[0].LI1[0].item9knownaddress_cb[0] (0.31 conf)
j_v_page_list_l_item__29 was JV-221[0].Page4[0].List10[0].LI1[0].item9knownaddress_tf[0] (0.31 conf)
j_v_page_sign_sub_text_fill was JV-221[0].Page4[0].SignSub[0].TextFill[0] (0.28 conf)
j_page_sign_date_time_field__2 was JV-221[0].Page4[0].SignSub[0].DateTimeField1[0] (0.34 conf)
j_v_page_sign_sub_name_ft__2 was JV-221[0].Page4[0].SignSub[0].YourName_ft[0] (0.40 conf)

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

Suggested Screen 0:

j_v_page_sub_court_info_ft
j_page_sub_court_name_ft
j_v_page_court_info_date
j_page_court_case_number_ft
j_v_page_sub_list_item_cb
j_v_page_sub_list_l_item__1
j_v_page_sub_list_l_item__2
j_v_sub_list_l_item__1
j_v_sub_list_l_item__2
j_v_sub_list_l_item_cb__1
j_v_page_sub_list_l_item__3
j_v_sub_list_l_item__3
j_v_sub_list_l_item__4
j_v_page_sub_list_l_item__4
j_v_page_sub_list_l_item__5
j_v_sub_list_l_item__5
j_v_sub_list_l_item__6
j_v_sub_list_l_item_cb__2
j_v_page_sub_list_l_item__6
j_v_sub_list_l_item__7
j_v_sub_list_l_item__8
j_v_page_sub_list_l_item__7
j_v_page_list_l_item__1
j_v_sub_list_l_item__9
j_v_sub_list_l_item__10
j_v_sub_list_l_item_cb__3
j_v_page_sub_list_l_item__8
j_sub_list_l_check_box
j_v_page_sub_list_l_specify
j_v_sub_list_l_item_cb__4
j_v_page_list_l_item_tx__1
j_v_page_sub_list_l_field__1
j_v_page_sub_list_l_field__2
j_v_sub_list_l_item_cb__5
j_v_sub_list_l_item_name
j_v_sub_list_l_item_reason
j_v_page_list_l_item_tx__2
j_v_page_case_number_ft__1
j_v_page_header_sub_childs_name_ft__1
j_v_list_l_item_caregiver
j_v_page_list_l_item_date__1
j_v_page_list_l_item_cb__1
j_v_page_list_l_item_cb__2
j_v_page_list_l_item_specify
j_v_page_list_l_item_cb__3
j_v_page_list_l_item_tf__1
j_v_page_sign_sub_item_adate__1
j_page_sign_date_name_item
j_sign_date_name_item_ft
j_v_sign_sub_item_cb
j_v_page_list_item_cb__1
j_v_page_list_l_item__2
j_v_page_list_l_item_adate__1
j_v_page_list_l_item__3
j_v_page_list_l_item_cb__4
j_v_page_list_l_item_tf__2
j_v_page_list_l_item_cb__5
j_v_page_list_l_item__4
j_v_page_list_l_item_tf__3
j_v_page_list_l_item_bdate__1
j_v_page_list_l_item__5
j_v_page_list_l_item_cb__6
j_v_page_list_l_item_tf__4
j_v_page_list_l_item_cb__7
j_v_page_list_l_item_tf__5
j_v_page_list_item_cb__2
j_v_page_list_l_item__6
j_v_page_list_l_item_adate__2
j_v_page_list_l_item__7
j_v_page_list_l_item_cb__8
j_v_page_list_l_item_tf__6
j_v_page_list_l_item_cb__9
j_v_page_list_l_item__8
j_v_page_list_l_item_tf__7
j_v_page_list_l_item_bdate__2
j_v_page_list_l_item__9
j_v_page_list_l_item_cb__10
j_v_page_list_l_item_tf__8
j_v_page_list_l_item_cb__11
j_v_page_list_l_item_tf__9
j_v_page_case_number_ft__2
j_v_page_header_sub_childs_name_ft__2
j_v_page_list_item_cb__3
j_v_page_list_l_item__10
j_v_page_list_l_item_adate__3
j_v_page_list_l_item_tf__10
j_v_page_list_l_item__11
j_v_page_list_l_item_cb__12
j_v_page_list_l_item__12
j_v_page_list_l_item_cb__13
j_v_page_list_l_item_tf__11
j_v_page_list_l_item__13
j_v_page_list_l_item__14
j_v_page_list_l_item__15
j_v_page_list_l_item_bdate__3
j_v_page_list_l_item_tf__12
j_v_page_list_l_item__16
j_v_page_list_l_item_cb__14
j_v_page_list_l_item__17
j_v_page_list_l_item_cb__15
j_v_page_list_l_item_ft
j_v_page_list_l_item__18
j_v_page_list_l_item__19
j_v_page_list_l_item__20
j_v_page_list_l_item_cdate
j_v_page_list_l_item_tf__13
j_v_page_list_l_item__21
j_v_page_list_l_item_cb__16
j_v_page_list_l_item__22
j_v_page_list_l_item_cb__17
j_v_page_list_l_item_tf__14
j_v_page_list_l_item__23
j_v_page_list_l_item__24
j_v_page_sign_sub_item_adate__2
j_page_sign_date_time_field__1
j_v_page_sign_sub_name_ft__1
j_v_page_sign_sub_name_cb
j_v_page_list_l_item_cb__18
j_v_page_list_l_item_tf__15
j_v_page_list_l_item_date__2
j_v_page_list_l_item_cb__19
j_v_page_list_l_item_cb__20
j_v_page_list_l_item_tf__16
j_v_page_list_l_item__25
j_v_page_list_l_item__26
j_v_page_list_l_item__27
j_v_page_case_number_ft__3
j_v_page_header_sub_childs_name_ft__3
j_v_page_list_l_item_cb__21
j_v_page_list_l_item_tf__17
j_v_list_l_item_date_tf
j_v_page_list_l_item_cb__22
j_v_page_list_l_item_cb__23
j_v_page_list_l_item_tf__18
j_v_page_list_l_item_cb__24
j_v_page_list_l_item_tf__19
j_v_page_list_l_item__28
j_v_page_list_l_item__29
j_v_page_sign_sub_text_fill
j_page_sign_date_time_field__2
j_v_page_sign_sub_name_ft__2

Create an Interactive Version of this Form:

The Weaver creates a draft guided interview from a template form, like the one provided here. You can use the link below to open this form in the Weaver. To learn more, read "Weaving" your form into a draft interview.

Launch Form in Weaver

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

Proof of Notice of Application

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