Request For Judicial Review Of Decision On Waiver Of Presumptive Transfer {JUV-273}

SDSC JUV-273 (New 3/18) REQUEST FOR JUDICIAL REVIEW OF DECISION ON Welf.& Inst. Code 247 14717.1(d) Mandatory Form WAIVER OF PRESUMPTIVE TRANSFER AND ORDER Page 1 of 3 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): TELEPHONE NO.: FAX NO.(Optional): EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, JUVENILE COURT, 2851 MEADOW LARK DR., SAN DIEGO, CA 92123 EAST COUNTY DIVISION, 250 E. MAIN ST., EL CAJON, CA 92020 NORTH COUNTY DIVISION, 325 S. MELROSE DR., SUITE 130, VISTA, CA 92081 IN THE MATTER OF A MINOR REQUEST FOR JUDICIAL REVIEW OF DECISION ON WAIVER OF PRESUMPTIVE TRANSFER AND ORDER CASE NO.: 1. Name of Person or Agency Requesting Judicial Review: Child Attorney for Child Parent Person/Agency Responsible for Making Mental Health Decisions for Child Juvenile Probation Department Health & Human Services Agency, Child Welfare Services Interested Party with Legal Duty Involving Child222s Health or Welfare Child222s Tribe Child222s Caregiver Child222s Court-Appointed Special Advocate (CASA) Other (describe): 2. Contact Information for Person or Agency Requesting Judicial Review: Street Address: City/State/Zip: Telephone Number: Email Address: 3. Child222s Attorney: 4. Child222s Social Worker: 5. Name(s) of Parent(s) or Legal Guardian(s): 6. Child222s Current Placement: 7. Person or Agency Requesting Waiver: 8. Decision on Waiver: Approved Denied 9. Date of Decision on Waiver: 10. Reason(s) Given for Decision on Waiver: . American LegalNet, Inc. www.FormsWorkFlow.com SDSC JUV-273 (New 3/18) REQUEST FOR JUDICIAL REVIEW OF DECISION ON Welf.& Inst. Code 247 14717.1(d) Mandatory Form WAIVER OF PRESUMPTIVE TRANSFER AND ORDER Page 2 of 3 11. If waiver was denied, which exception(s) to presumptive transfer (Welf. & Inst. Code 247 14717.1(d)(5)) do you claim? The transfer would disrupt continuity of care or delay access to services provided to the child. The transfer would interfere with family reunification efforts documented in the individual case plan. The child's placement in a county other than the County of San Diego is expected to last less than six months. The child's residence is within 30 minutes of travel time to his or her established specialty mental health care provider in the County of San Diego. 12. As required by Welf. & Inst. Code 247 14717.1(d)(6), the County of San Diego: has an existing contract with a specialty mental health care provider or has the ability to enter into an existing contract with a specialty mental health care provider within 30 days of the waiver decision and has the ability to deliver timely specialty mental health services directly to the child. 13. Reasons why it is in the best interest of the child to waive presumptive transfer: deny a waiver of presumptive transfer: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Signature of Requestor INSTRUCTIONS: The following parties must be given notice of this request at least 10 calendar days before the request is submitted to the court. Each party must be served either personally or by first-class mail with a copy of the request. San Diego Office of County Counsel Health & Human Services Agency/CWS Juvenile Dependency Division Attn: Legal Unit 5530 Overland Avenue, Suite 170 8965 Balboa Avenue San Diego, CA 92123 San Diego, CA 92123 Children222s Legal Services of San Diego Dependency Legal Services of San Diego 4801 Viewridge Avenue 1660 Hotel Circle North San Diego, CA 92123 San Diego, CA 92108 File this request and any attachments with the Juvenile Court Business Office at the court location where the child222s case is being heard (see addresses on page 1). If your request involves more than one child, complete one form for each child. A completed Proof of Service (SDSC Form #POS-020 and/or SDSC Form #POS-030) must accompany the request when the request is filed with the court. If you know of any parties not represented by counsel or a privately retained attorney who is representing a party, please ask the court clerk for assistance. IN THE MATTER OF: CASE NUMBER: American LegalNet, Inc. www.FormsWorkFlow.com SDSC JUV-273 (New 3/18) REQUEST FOR JUDICIAL REVIEW OF DECISION ON Welf.& Inst. Code 247 14717.1(d) Mandatory Form WAIVER OF PRESUMPTIVE TRANSFER AND ORDER Page 3 of 3 FOR COURT USE ONLY Presumptive transfer is waived. Presumptive transfer is not waived. Hearing set for (date) at (time) a.m. p.m. in Department: . Request is returned for proper service. Comments: IT IS SO ORDERED. Date: Judge/Referee of the Superior Court IN THE MATTER OF: CASE NUMBER: www.FormsWorkFlow.com