DV-177

Notice of Request for Release of 
Minor's Confidential Information

Clerk stamps date here when form is filed.

The court sent you this notice because someone has asked the court 
to release confidential information about a minor. 
You have the right to tell the court if you disagree with the request to 
release confidential information. You have until the deadline listed 
below in item       . For instructions on next steps, go to page 2.

4

1 Parties in this case 

a. Protected Party (check one):

Name of protected party is:

Name of protected party is confidential in this case

b. Restrained Party (check one):

Name of restrained party is:

Name of restrained party is confidential in this case

Fill in court name and street address:

Superior Court of California, County of

Court fills in case number when form is filed.

Case Number:

2 Person asking for minor's confidential information

Full Name:
been made confidential in this case. To see what information the person wants access to, see form 
DV-176, Request for Release of Minor's Confidential Information, which is included with this notice.

wants access to information that has  

3 You are receiving this notice because:

You are the minor who asked to keep your information confidential.

You are the parent or legal guardian who asked to keep minor's information confidential

4 Deadline to disagree with request

The person in       has until (date)
3

to file a completed form DV-178,

Response to Request for Release of Minor's Confidential Information, with the court clerk. Form 
DV-178 is included with this notice.

Judicial Council of California,  
Rev. January 1, 2021, Mandatory Form  
Family Code, § 6301.5

www.courts.ca.gov

Notice of Request for Release 
of Minor's Confidential Information 
(Domestic Violence Prevention)

DV-177, Page 1 of 2

[seal]

Case Number:

—Clerk's Certificate—

I certify that I am not a party to this case and that a true copy of the Notice of Request 
for Release of Information (form DV-177), blank copy of the Response to Request for 
Release of Minor's Confidential Information (form DV-178) and Cover Sheet for 
Confidential Information (form DV-175), and a true copy of the Request for Release of 
Minor's Confidential Information (form DV-176) were mailed first class, postage fully 
prepaid, in a sealed envelope to the person in       .3

a. Date of mailing:

(Instructions to clerk for item 4: The deadline is the first court day after 20 days 
from the date of mailing)

b. Mailed from the courthouse listed on page 1.

c. Mailed to the address of person in      , provided to the court on form DV-160, 
    Request to Keep Minor's Information Confidential, filed on

3

(date)

Date:

Clerk, by

, Deputy

Next Steps for Person in

3

Form DV-176, Request for Release of Minor's Confidential Information, is 
included with this notice. Take a close look at form DV-176 to see who made 
the request (item       ) and what confidential information the person is asking  
the court to release (page 2). 

2

A blank copy of form DV-178, Response to Request for Release of Minor's 
Confidential Information, is also included with this notice. If you do not agree with 
the request to release confidential information, you must complete form DV-178 and 
file it with the court clerk by the deadline listed in item       on page 1 of this form 
DV-177. You can also find form DV-178 at 

4

After the judge makes a decision, you should receive a copy of the judge's order 
on form DV-179, Order on Request for Release of Minor's Confidential 
Information. If you do not receive a copy of the judge's order, you can contact 
the court to get a copy.

Rev. January 1, 2021

DV-177, Page 2 of 2

Notice of Request for Release 
of Minor's Confidential Information 
(Domestic Violence Prevention)