ATTORNEY OR PARTY WITHOUT ATTORNEY:

STATE BAR NO.:

FOR COURT USE ONLY

JV-822

STATE:

FAX NO.:

ZIP CODE:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

NAME:

FIRM NAME:

STREET ADDRESS:

CITY:

TELEPHONE NO.:

E-MAIL ADDRESS:

ATTORNEY FOR (name):

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

CASE NAME:

NOTICE OF INTENT TO FILE WRIT PETITION AND REQUEST FOR RECORD 
TO REVIEW ORDER DESIGNATING OR DENYING SPECIFIC PLACEMENT 
OF A DEPENDENT CHILD AFTER TERMINATION OF PARENTAL RIGHTS 
(California Rules of Court, Rule 8.454)

CASE NUMBER:

NOTICE  

The juvenile court has ordered or denied a specific placement for this child. If you want an appeals court to review the 
juvenile court's decision, you must first tell the juvenile court by filing a Notice of Intent. You may use this form as your 
Notice of Intent. In most cases, you have only 7 days from the court's placement decision to file a Notice of Intent. Please 
see page 2 for your specific deadline for filing this form.

If you are not the county welfare department, child, child's parent, or child's legal guardian, you may have a right to 
challenge a decision by the juvenile court, but only in very limited circumstances. You may need a court order granting you 
access to records in the juvenile case file. For more information, please see Information on Requesting Access to Records 
for Persons With a Limited Right to Appeal (form JV-291-INFO). You can get form JV-291-INFO at any courthouse or county 
law library or online at www.courts.ca.gov/forms.

Petitioner's name:

Petitioner's address:

Petitioner's phone number:

Petitioner is

child's caretaker (specify dates in your care):
child.
county welfare department.
legal guardian.
other (state relationship to child or interest in the case):

1.

2.

3.

4.

7.

a.
b.
c.
d.
e.

b.

5.

Child's name:

6. a.

On (date):
section 366.26. 

 Child's date of birth:  

the juvenile court terminated parental rights under Welfare and Institutions Code   

the court made a specific placement order or denied a specific placement request  
On (date):  
that the dependent child is to reside in, be retained in, or be removed from a specific placement. Petitioner intends to file a writ  
petition to challenge the specific placement order or the denial of a specific placement request made by the court on that date  
and requests that the clerk assemble the record.

Petitioner has been granted access to specified records in the juvenile case file, and a copy of the court's order under 
Welfare and Institutions Code section 827(a)(1)(Q), on Order After Judicial Review on Petition for Access to Juvenile Case 
File (form JV-574), if available, is attached.

PLEASE READ THE BACK OF THIS FORM FOR IMPORTANT INFORMATION AND DEADLINES

Form Approved for Optional Use 
Judicial Council of California 
JV-822 [Rev. September 1, 2020]

NOTICE OF INTENT TO FILE WRIT PETITION AND REQUEST FOR 
RECORD TO REVIEW ORDER DESIGNATING OR DENYING 
SPECIFIC PLACEMENT OF A DEPENDENT CHILD AFTER 
TERMINATION OF PARENTAL RIGHTS 
(California Rules of Court, Rule 8.454)

Page 1 of 2

Welfare and Institutions Code, 
§ 366.28; Cal. Rules of Court, rule 8.454;
www.courts.ca.gov

APPELLATE CASE TITLE:

APPELLATE CASE NUMBER:

JV-822

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF

PETITIONER

ATTORNEY)

The Notice of Intent to File Writ Petition must be signed by the person intending to file the writ petition or, by the 
attorney of record. See below for more information.

HOW DO I CHALLENGE THE COURT’S PLACEMENT DECISION AFTER TERMINATION 
OF PARENTAL RIGHTS? 
•  File this Notice of Intent to File Writ Petition and Request for Record in the juvenile court within the time listed 
below in the next box. This will let the court know you intend to file a writ petition, and the court will prepare the 
record. 

• You will be notified after the record is filed in the Court of Appeal, and you will get a copy of the record. You 

have 10 days after the record is filed in the Court of Appeal to file and serve your writ petition.

• You may use the optional Judicial Council form JV-825 to complete your writ petition, or, if you have an 

attorney, your attorney can write the writ petition for you. 

• After you file a writ petition in the Court of Appeal you must send a copy of the petition to all of the parties in 
the case, to the child’s CASA volunteer, to the child’s present caregiver, and to any de facto parent who has 
standing to participate in the juvenile court proceedings. 

SEE CAL. RULES OF COURT, RULES 8.454–8.456  

WHEN DO I HAVE TO FILE MY NOTICE OF INTENT TO FILE WRIT PETITION AND 
REQUEST FOR  RECORD? 

• If you were present when the court granted or denied the specific placement, you must file the Notice of Intent 

within 7 days from the date the court granted or denied the specific placement. 

• If you were not present in court but were given notice by mail of the court’s decision to grant or deny the 
specific placement, you must file the Notice of Intent within 12 days from the date the clerk mailed the 
notification. 

• If the order granting or denying the specific placement was made by a referee not acting as a temporary judge, 

you must file the Notice of Intent within 17 days from the date the court set the hearing.

WHO MUST SIGN THE NOTICE OF INTENT? 

The person who intends to file the writ petition; or
The attorney of record for the person who intends to file the writ petition

JV-822 [Rev. September 1, 2020]

Page 2 of 2

NOTICE OF INTENT TO FILE WRIT PETITION AND REQUEST FOR 
RECORD TO REVIEW ORDER DESIGNATING OR DENYING 
SPECIFIC PLACEMENT OF A DEPENDENT CHILD AFTER 
TERMINATION OF PARENTAL RIGHTS 
(California Rules of Court, Rule 8.454)