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Here is the text we could read:

CHILD'S NAME:

CASE NUMBER:

JV-667

CUSTODIAL AND OUT-OF-HOME PLACEMENT DISPOSITION ATTACHMENT

THE COURT FINDS AND ORDERS

The maximum time the child may be confined

in secure custody for the offenses sustained in the petition before the court is (specify time):

in the petition before the court, with the terms of all previously sustained petitions known to the court
aggregated, is (specify time):

The child is committed to:

days

months in juvenile hall

and is remanded forthwith. Continuance in the home is contrary to the child's welfare.

and is to report to (name):

with credit for:

days served.

pm on (date):

The welfare of the child requires that physical custody be removed from the parent or guardian. (Check only if applicable.)

The child's parent or guardian has failed or neglected to provide, or is incapable of providing, proper maintenance,
training, and education for the child.

The child has been on probation in the custody of the parent or guardian and has failed to reform.

c. Continuance in the home is contrary to the child's welfare.

The probation department is granted the authority to authorize medical, surgical, dental, or other remedial care under
Welf. & Inst. Code, § 739.

Reasonable efforts to prevent or eliminate the need for removal

have been made.

have not been made.

The case plan as described in Welf. & Inst. Code, § 706.6
the court within 60 days of the child's initial removal.

has been filed with the court

will be filed with

7. a.

The probation officer will ensure provision of reunification services, and the following are ordered to participate in the
reunification services specified in the case plan:

Mother

Biological father

Legal guardian

Presumed father

Alleged father
Other (specify):

Indian custodian

Other (specify):

Reunification services do not need to be provided to (name):
because the court finds by clear and convincing evidence that (check one)

reunification services were previously terminated for that parent under Welf. & Inst. Code, §§ 366.21, 366.22, or
366.25, or not offered under § 361.5(b) in reference to the same child.

that parent has been convicted of
another child of the parent
manslaughter of another child of the parent
another child of the parent.

murder of another child of the parent

voluntary manslaughter of

aiding, abetting, attempting, conspiring, or soliciting to commit murder or

felony assault resulting in serious bodily injury to the child or

(3)

the parental rights of that parent to a sibling of the child have been terminated involuntarily, and it is not in the best
interest of the child to reunify with their parent or legal guardian.

The child is
placement in a suitable relative's home or in a foster or group home.

continued in

ordered to

the care, custody, and control of the probation officer for

(1)

(2)

The following are ordered to meet with the probation officer on a monthly basis:

Mother

Biological father

Legal guardian

Presumed father

Alleged father

Indian custodian

Other (specify):

Form Approved for Optional Use
Judicial Council of California
JV-667 [Rev. January 1, 2023]

CUSTODIAL AND OUT-OF-HOME PLACEMENT
DISPOSITION ATTACHMENT

Page 1 of 3
Welfare and Institutions Code,
§§ 702, 706.6, 725, 726.4, 727, 727.1, 727.2,
Cal. Rules of Court, rules 5.785, 5.790, 5.795

CHILD'S NAME:

CASE NUMBER:

JV-667

7. e.

The child is ordered to obey all reasonable directives of placement staff and probation officer. The child is not to
leave placement without the permission of probation officer or placement staff.

Pending placement, the child is detained in juvenile hall. If being housed in another county, please specify county:

(1)

(2)

(3)

The child is placed on home supervision in the home of

(1)

(2)

(3)

(4)

(5)

parent (name):

legal guardian (name):

Other (name and address):

and is subject to electronic monitoring.

mother father

The parent or legal guardian must cooperate in the completion and signing of necessary documents to qualify the child for
any medical or financial benefits to which the child may be entitled.

The county is authorized to pay for care, maintenance, clothing, and incidentals at the approved rate.

The likely date by which the child may be returned to and safely maintained in the home or another permanent plan
selected is (date):

The right of the parent or guardian to make educational decisions for the child is specifically limited. Order Designating
Educational Rights Holder (form JV-535) will be completed and transmitted.

The care, custody, and control of the child has been ordered to be under the supervision of the probation officer for foster
care placement under Welf. & Inst. Code, § 727(a). Consistent with Welf. & Inst. Code, § 726.4, the court has inquired of the
mother and any other appropriate person as to the identity and address of all presumed or alleged fathers.

The child has been ordered into a placement described by title IV-E of the Social Security Act.

The date the child entered foster care is:

, which is 60 days after the day the child was

removed from their home.

An exception applies to the standard calculation of the date the child entered foster care because

the child has been detained for more than 60 days. Therefore, the date the child entered foster care is today's date
of:

the child has been in a ranch, camp, or other institution for more than 60 days and is now being ordered into an
eligible placement. The date the child enters foster care will be the date the child is moved into the eligible placement
facility, which is anticipated to be:

at the time the wardship petition was filed, the child was a dependent of the juvenile court and in an out-of-home
placement. Thus, the date entered foster care is unchanged from the date the child entered foster care in dependency
court. That date is:

10.

The child is committed to the care, custody, and control of the probation department for placement in the county juvenile
ranch camp or forestry camp:

for:

months

days.

until the requirements of the program have been satisfactorily completed.

11.

If being housed in another county, please specify:

JV-667 [Rev. January 1, 2023]

Page 2 of 3

CUSTODIAL AND OUT-OF-HOME PLACEMENT
DISPOSITION ATTACHMENT

CHILD'S NAME:

CASE NUMBER:

JV-667

12.

The child is placed in a short-term residential therapeutic program or community treatment facility. A hearing to review the
placement under Welf. & Inst. Code, § 727.12 was held on or is set for (date):

Date:

Judicial Officer

JV-667 [Rev. January 1, 2023]

Page 3 of 3

CUSTODIAL AND OUT-OF-HOME PLACEMENT
DISPOSITION ATTACHMENT

Custodial and Out-of-Home Placement Disposition Attachment

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): 3
Fields(s): 115
Average fields per page: 38
Reading Level: Grade 11
LIST Grouping(s): FA-00-00-00-00, ES-03-00-00-00.

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_sf_number_ft was JV-667[0].Page1[0].CaptionP1_sf[0].CaseNumber_ft[0] (0.56 conf)
j_v_page_caption_p_sf was JV-667[0].Page1[0].CaptionP1_sf[0].childsname[0] (0.30 conf)
j_v_page_item_petitioner_cb__1 was JV-667[0].Page1[0].Item1[0].petitioner_cb[0] (0.32 conf)
j_v_page_item_checkbox__1 was JV-667[0].Page1[0].Item1[0].checkbox1a[0] (0.32 conf)
j_v_page_item_specifyname was JV-667[0].Page1[0].Item1[0].specifyname1a[0] (0.32 conf)
j_v_page_item_checkbox_b__1 was JV-667[0].Page1[0].Item1[0].checkbox1b[0] (0.32 conf)
j_v_page_item_specifytime_b was JV-667[0].Page1[0].Item1[0].specifytime1b[0] (0.32 conf)
j_v_page_item_petitioner_cb__2 was JV-667[0].Page1[0].Item2[0].petitioner_cb[0] (0.32 conf)
j_v_page_item_ftdays was JV-667[0].Page1[0].Item2[0].ftdays2[0] (0.32 conf)
j_v_page_item_ftmonths was JV-667[0].Page1[0].Item2[0].ftmonths2[0] (0.32 conf)
j_v_page_item_cb_aremanded was JV-667[0].Page1[0].Item2[0].cb2aremanded[0] (0.32 conf)
j_v_page_item_anistoreportto_b was JV-667[0].Page1[0].Item2[0].anistoreportto2b[0] (0.32 conf)
j_v_page_item_reportname_b was JV-667[0].Page1[0].Item2[0].reportname2b[0] (0.32 conf)
j_v_page_item_b__1 was JV-667[0].Page1[0].Item2[0].by2b[0] (0.32 conf)
j_v_page_item_ampm_b__1 was JV-667[0].Page1[0].Item2[0].ampm2b[0] (0.32 conf)
j_v_page_item_ampm_b__2 was JV-667[0].Page1[0].Item2[0].ampm2b[1] (0.32 conf)
j_v_page_item_timeanddate_b was JV-667[0].Page1[0].Item2[0].timeanddate2b[0] (0.32 conf)
j_v_page_item_xcreditfor was JV-667[0].Page1[0].Item2[0].checkbox2xcreditfor[0] (0.32 conf)
j_v_page_item_dayserved_c was JV-667[0].Page1[0].Item2[0].dayserved2c[0] (0.32 conf)
j_v_page_item_welfareofchild was JV-667[0].Page1[0].Item3[0].welfareofchild3[0] (0.32 conf)
j_v_page_item_check_box__1 was JV-667[0].Page1[0].Item3[0].CheckBox3a[0] (0.31 conf)
j_v_item_b was JV-667[0].Page1[0].Item3[0].childhasbeenonprobation3b[0] (0.32 conf)
j_v_page_item_check_box__2 was JV-667[0].Page1[0].Item4[0].CheckBox4[0] (0.31 conf)
j_v_page_item_petitioner_cb__3 was JV-667[0].Page1[0].Item5[0].petitioner_cb[0] (0.32 conf)
j_v_page_item_checkbox_b__2 was JV-667[0].Page1[0].Item5[0].checkbox5a_b[0] (0.32 conf)
j_v_page_item_checkbox_b__3 was JV-667[0].Page1[0].Item5[0].checkbox5a_b[1] (0.32 conf)
j_v_page_item_filed was JV-667[0].Page1[0].Item6[0].filed6[0] (0.32 conf)
j_v_page_item_hasbeenfiled was JV-667[0].Page1[0].Item6[0].hasbeenfiled[0] (0.32 conf)
j_v_page_item_willbefiled was JV-667[0].Page1[0].Item6[0].willbefiled[0] (0.32 conf)
j_v_page_item_check_box__3 was JV-667[0].Page1[0].Item7a[0].CheckBox67a[0] (0.31 conf)
j_v_page_item_checkbox__2 was JV-667[0].Page1[0].Item7a[0].checkboxM7a[0] (0.32 conf)
j_v_page_item_checkbox_b_f was JV-667[0].Page1[0].Item7a[0].checkboxBF7a[0] (0.30 conf)
j_v_page_item_checkbox_lg was JV-667[0].Page1[0].Item7a[0].checkboxLg7a[0] (0.32 conf)
j_v_page_item_checkbox_p_f was JV-667[0].Page1[0].Item7a[0].checkboxPF7a[0] (0.30 conf)
j_v_page_item_checkbox_f was JV-667[0].Page1[0].Item7a[0].checkboxAF7a[0] (0.36 conf)
j_v_page_item_checkbox_ic was JV-667[0].Page1[0].Item7a[0].checkboxIc7a[0] (0.32 conf)
j_v_page_item_checkbox__3 was JV-667[0].Page1[0].Item7a[0].checkboxO17a[0] (0.32 conf)
j_v_page_item_cb_fi_specify__1 was JV-667[0].Page1[0].Item7a[0].Cb7a_FiSpecify1[0] (0.35 conf)
j_v_page_item_checkbox__4 was JV-667[0].Page1[0].Item7a[0].checkboxO27a[0] (0.32 conf)
j_v_page_item_cb_fi_specify__2 was JV-667[0].Page1[0].Item7a[0].Cb7a_FiSpecify2[0] (0.35 conf)
j_v_page_item_b_check_box__1 was JV-667[0].Page1[0].Item7b[0].CheckBox7b[0] (0.31 conf)
j_v_page_item_b_f_name was JV-667[0].Page1[0].Item7b[0].FI7_name[0] (0.33 conf)
j_v_page_item_b_check_box__2 was JV-667[0].Page1[0].Item7b[0].CheckBox7b1[0] (0.31 conf)
j_v_page_item_b_cb was JV-667[0].Page1[0].Item7b[0].cb2thatparent[0] (0.32 conf)
j_v_page_item_b_checkbox_lg was JV-667[0].Page1[0].Item7b[0].checkboxLg7b2[0] (0.32 conf)
j_v_page_item_b_cbmanslaug was JV-667[0].Page1[0].Item7b[0].cbmanslaug7b2[0] (0.32 conf)
j_v_page_item_b_checkboxaiging was JV-667[0].Page1[0].Item7b[0].checkboxaiging7b2[0] (0.32 conf)
j_v_page_item_b_checkboxfelony was JV-667[0].Page1[0].Item7b[0].checkboxfelony7b2[0] (0.32 conf)
j_v_page_item_b__2 was JV-667[0].Page1[0].Item7b[0].parentalrightcb7b3[0] (0.32 conf)
j_v_page_item_c_checkbox_lg__1 was JV-667[0].Page1[0].Item7c[0].checkboxLg7a[0] (0.32 conf)
j_v_page_item_c_checkbox_lg__2 was JV-667[0].Page1[0].Item7c[0].checkboxLg7a[1] (0.32 conf)
j_v_page_item_c_checkbox_lg__3 was JV-667[0].Page1[0].Item7c[0].checkboxLg7a[2] (0.32 conf)
j_v_page_item_ordered was JV-667[0].Page1[0].item7d[0].ordered7d[0] (0.35 conf)
j_v_page_item_cb__1 was JV-667[0].Page1[0].item7d[0].cb7dM[0] (0.35 conf)
j_v_page_item_cb_b_f was JV-667[0].Page1[0].item7d[0].cb7dBF[0] (0.30 conf)
j_v_page_item_cb_l_g was JV-667[0].Page1[0].item7d[0].cb7dLG[0] (0.39 conf)
j_v_page_item_cb_p_f was JV-667[0].Page1[0].item7d[0].cb7dPF[0] (0.30 conf)
j_v_page_item_cb_f was JV-667[0].Page1[0].item7d[0].cb7dAF[0] (0.33 conf)
j_v_page_item_cb_c was JV-667[0].Page1[0].item7d[0].cb7dIC[0] (0.28 conf)
j_v_page_item_cb__2 was JV-667[0].Page1[0].item7d[0].cb7dO1[0] (0.35 conf)
j_v_page_item_specify__1 was JV-667[0].Page1[0].item7d[0].Specify7do1[0] (0.32 conf)
j_v_page_item_cb__3 was JV-667[0].Page1[0].item7d[0].cb7dO2[0] (0.35 conf)
j_v_page_item_specify__2 was JV-667[0].Page1[0].item7d[0].Specify7do2[0] (0.32 conf)
j_v_page_item_e_check_box was JV-667[0].Page2[0].item7[0].item7e[0].CheckBox7e[0] (0.27 conf)
j_v_page_item_f was JV-667[0].Page2[0].item7[0].item7f[0].pendingplacement7f[0] (0.35 conf)
j_v_page_item_f_specifycounty was JV-667[0].Page2[0].item7[0].item7f[0].specifycounty7f[0] (0.35 conf)
j_v_page_item_g was JV-667[0].Page2[0].item7[0].item7g[0].homesupervision7g[0] (0.35 conf)
j_v_page_item_g_check_box was JV-667[0].Page2[0].item7[0].item7g[0].CheckBox61[0] (0.27 conf)
j_v_page_item_g_cb__1 was JV-667[0].Page2[0].item7[0].item7g[0].cb7g1_parentname[0] (0.35 conf)
j_v_page_item_g_area__1 was JV-667[0].Page2[0].item7[0].item7g[0].#area[0].motherfather[0] (0.35 conf)
j_v_item_g_area_cb_father__1 was JV-667[0].Page2[0].item7[0].item7g[0].#area[1].cb7g1_father[0] (0.35 conf)
j_v_page_item_area_check_box__1 was JV-667[0].Page2[0].item7[0].item7g[0].#area[2].CheckBox61[1] (0.27 conf)
j_v_page_item_g_cb__2 was JV-667[0].Page2[0].item7[0].item7g[0].cb7g2_parentname[0] (0.35 conf)
j_v_item_g_area_cb_mother was JV-667[0].Page2[0].item7[0].item7g[0].#area[3].cb7g2_mother[0] (0.35 conf)
j_v_item_g_area_cb_father__2 was JV-667[0].Page2[0].item7[0].item7g[0].#area[4].cb7g2_father[0] (0.35 conf)
j_v_page_item_area_check_box__2 was JV-667[0].Page2[0].item7[0].item7g[0].#area[5].CheckBox61[2] (0.27 conf)
j_v_page_item_g_cb__3 was JV-667[0].Page2[0].item7[0].item7g[0].cb7g3_legalguardian[0] (0.35 conf)
j_v_page_item_area_check_box__3 was JV-667[0].Page2[0].item7[0].item7g[0].#area[6].CheckBox61[3] (0.27 conf)
j_v_page_item_g_cb__4 was JV-667[0].Page2[0].item7[0].item7g[0].cb7g4_other[0] (0.35 conf)
j_v_page_item_g_area__2 was JV-667[0].Page2[0].item7[0].item7g[0].#area[7].petitioner_cb[0] (0.35 conf)
j_v_page_item_area_check_box__4 was JV-667[0].Page2[0].item7[0].item7g[0].#area[8].CheckBox61[4] (0.27 conf)
j_v_page_item_g_cb__5 was JV-667[0].Page2[0].item7[0].item7g[0].cb7g5_other[0] (0.35 conf)
j_page_item_h_area_check_box was JV-667[0].Page2[0].item7[0].item7h[0].#area[0].CheckBox61[0] (0.27 conf)
j_v_page_item_area_cb__1 was JV-667[0].Page2[0].item7[0].item7i[0].#area[0].petitioner_cb[0] (0.35 conf)
j_v_page_item_area_check_box__5 was JV-667[0].Page2[0].item7[0].item7j[0].#area[0].CheckBox61[0] (0.27 conf)
j_page_item_area_date_field was JV-667[0].Page2[0].item7[0].item7j[0].#area[0].DateField5[0] (0.31 conf)
j_v_page_item_area_check_box__6 was JV-667[0].Page2[0].item7[0].item7k[0].#area[0].CheckBox61[0] (0.27 conf)
j_v_page_item_petitioner_cb__4 was JV-667[0].Page2[0].item8[0].petitioner_cb7[0] (0.35 conf)
j_v_page_case_number_ft__1 was JV-667[0].Page2[0].headerpg2[0].CaseNumber_ft[0] (0.34 conf)
j_v_page_headerpg_childsname__1 was JV-667[0].Page2[0].headerpg2[0].childsname[0] (0.35 conf)
j_v_page_item_area_cb__2 was JV-667[0].Page2[0].item9[0].#area[0].petitioner_cb[0] (0.35 conf)
j_v_page_item_check_box__4 was JV-667[0].Page2[0].item9[0].item9a[0].CheckBox61[0] (0.27 conf)
j_v_page_item_date_field was JV-667[0].Page2[0].item9[0].item9a[0].DateField2[0] (0.31 conf)
j_v_page_item_b_carebecause__1 was JV-667[0].Page2[0].item9[0].item9b[0].carebecause9b[0] (0.35 conf)
j_v_page_item_b_date_field__1 was JV-667[0].Page2[0].item9[0].item9b[0].DateField6[0] (0.31 conf)
j_v_page_item_b_carebecause__2 was JV-667[0].Page2[0].item9[0].item9b[0].carebecause9b[1] (0.35 conf)
j_v_page_item_b_date_field__2 was JV-667[0].Page2[0].item9[0].item9b[0].DateField3[0] (0.31 conf)
j_v_page_item_b_carebecause__3 was JV-667[0].Page2[0].item9[0].item9b[0].carebecause9b[2] (0.35 conf)
j_v_page_item_b_date_field__3 was JV-667[0].Page2[0].item9[0].item9b[0].DateField4[0] (0.31 conf)
j_v_page_item_b_petitioner_cb was JV-667[0].Page2[0].item9[0].item9b[0].petitioner_cb[0] (0.35 conf)
j_v_page_item_area_check_box__7 was JV-667[0].Page2[0].item10[0].#area[0].CheckBox61[0] (0.27 conf)
j_v_page_item_text_field__1 was JV-667[0].Page2[0].item10[0].TextField3[0] (0.31 conf)
j_v_page_item_area_cb__3 was JV-667[0].Page2[0].item10[0].item10a[0].#area[0].cb10a_for[0] (0.35 conf)
j_v_page_item_cb_months was JV-667[0].Page2[0].item10[0].item10a[0].cb10a_months[0] (0.35 conf)
j_v_page_item_cb_days was JV-667[0].Page2[0].item10[0].item10a[0].cb10a_days[0] (0.35 conf)
j_v_page_item_text_field__2 was JV-667[0].Page2[0].item10[0].item10a[0].TextField5[0] (0.31 conf)
j_v_page_item_text_field__3 was JV-667[0].Page2[0].item10[0].item10a[0].TextField4[0] (0.31 conf)
j_v_item_b_area was JV-667[0].Page2[0].item10[0].item10b[0].#area[0].cb10b_untiltherequirements[0] (0.35 conf)
j_v_page_item_area_cb__4 was JV-667[0].Page2[0].item11[0].#area[0].petitioner_cb[0] (0.35 conf)
j_v_page_item_text_name was JV-667[0].Page2[0].item11[0].Text06\.a\.name[0] (0.32 conf)
j_v_page_sign_sub_date was JV-667[0].Page3[0].SignSub[0].Date[0] (0.32 conf)
j_v_page_case_number_ft__2 was JV-667[0].Page3[0].headerpg3[0].CaseNumber_ft[0] (0.34 conf)
j_v_page_headerpg_childsname__2 was JV-667[0].Page3[0].headerpg3[0].childsname[0] (0.35 conf)
j_v_page_area_check_box was JV-667[0].Page3[0].#subform[2].#area[0].CheckBox61[0] (0.27 conf)
j_v_page_subform_date_field was JV-667[0].Page3[0].#subform[2].DateField1[0] (0.31 conf)

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

Suggested Screen 0:

j_v_page_p_sf_number_ft
j_v_page_caption_p_sf
j_v_page_item_petitioner_cb__1
j_v_page_item_checkbox__1
j_v_page_item_specifyname
j_v_page_item_checkbox_b__1
j_v_page_item_specifytime_b
j_v_page_item_petitioner_cb__2
j_v_page_item_ftdays
j_v_page_item_ftmonths
j_v_page_item_cb_aremanded
j_v_page_item_anistoreportto_b
j_v_page_item_reportname_b
j_v_page_item_b__1
j_v_page_item_ampm_b__1
j_v_page_item_ampm_b__2
j_v_page_item_timeanddate_b
j_v_page_item_xcreditfor
j_v_page_item_dayserved_c
j_v_page_item_welfareofchild
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