California > Judicial Council > Juvenile

Dispositional Attachment Removal From Custodial Parent-Placement With Nonparent JV-421 - California

Dispositional Attachment Removal From Custodial Parent-Placement With Nonparent Form. This is a California form and can be used in Juvenile Judicial Council .
 Fillable pdf Last Modified 12/31/2013
Get this form for FREE as a print-only pdf

JV-421 CHILD'S NAME: CASE NUMBER: DISPOSITIONAL ATTACHMENT: REMOVAL FROM CUSTODIAL PARENT--PLACEMENT WITH NONPARENT (Welf. & Inst. Code, §§ 361, 361.2) 1. The child is a person described by Welf. & Inst. Code, § 300 (check all that apply): 300(g) 300(c) 300(i) 300(a) 300(e) 300(h) 300(d) 300(j) 300(b) 300(f) and is adjudged a dependent of the court. Circumstances justifying removal from custodial parent 2. There is clear and convincing evidence of the circumstances stated in Welf. and Inst. Code, § 361 regarding the persons specified below (check all that apply): 361(c)(1) 361(c)(2) 361(c)(3) 361(c)(4) 361(c)(5) a. b. c. d. e. f. 3. Mother Presumed father Biological father Legal guardian Indian custodian Other (specify): The child is may be an Indian child, and, by clear and convincing evidence, including testimony of a qualified expert witness, continued physical custody by the following person is likely to cause that child serious emotional or physical damage. biological father legal guardian mother presumed father Indian custodian other (specify): 4. Reasonable efforts 5. The child a. b. c. were were not made to prevent or eliminate the need for removal from the home. is may be an Indian child, and, by clear and convincing evidence, active efforts were made to provide remedial services and rehabilitative programs designed to prevent the breakup of this Indian family, and these efforts were unsuccessful. active efforts were not made to provide remedial services and rehabilitative programs designed to prevent the breakup of this Indian family. there has been consultation with the child's identified Indian tribe regarding whether tribal customary adoption is an appropriate permanent plan for the child if reunification is unsuccessful. 6. Based on the facts stated on the record, continuance in the home is contrary to the child's welfare and physical custody is removed from (check all that apply): Mother Presumed father Other (specify): Family finding and engagement 7. a. b. The county agency has made diligent efforts to identify, locate, and contact the child's relatives. The county agency has not made diligent efforts to identify, locate, and contact the child's family members. (1) (2) The county agency is ordered to make such diligent efforts, except for individuals the agency has determined to be inappropriate to contact because of their involvement with family or domestic violence. The county agency must submit a report to the court on or before (date): detailing the diligent efforts made and the results of such efforts. Page 1 of 7 Form Approved for Optional Use Judicial Council of California JV-421 [Rev. January 1, 2017] Biological father Indian custodian Legal guardian DISPOSITIONAL ATTACHMENT: REMOVAL FROM CUSTODIAL PARENT--PLACEMENT WITH NONPARENT (Welf. & Inst. Code, §§ 361, 361.2) Welfare and Institutions Code, §§ 361, 361.2; Cal. Rules of Court, rule 5.695 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com JV-421 CHILD'S NAME: CASE NUMBER: Case plan development 8. a. b. The county agency solicited and integrated into the case plan the input of the representative of child's identified Indian tribe other (specify): child mother father father The county agency did not solicit and integrate into the case plan the input of the mother child representative of child's identified Indian tribe other (specify): and the agency is ordered to do so and submit an updated case plan within 30 days of the date of this hearing. c. The county agency did not solicit and integrate into the case plan the input of the mother father child representative of child's identified Indian tribe other (specify): and the agency is not required to do so because these persons are unable, unavailable, or unwilling to participate. Custody and Placement 9. The a. mother was filed and presumed father does does not biological father did not reside with the child at the time the petition desire custody of the child. By clear and convincing evidence, placement with the following parent would be detrimental to the safety, protection, or physical or emotional well-being of the child: Mother Presumed father Biological father b. The factual basis for the findings in this item is stated on the record. 10. The care, custody, control, and conduct of the child is under the supervision of the county agency for placement a. b. c. d. e. f. 11. in the approved home of a relative. in the approved home of a nonrelative extended family member. in the foster home in which the child was placed before an interruption in foster care because that placement is in the child's best interest and space is available. with a foster family agency for placement in a foster family home. in a suitable licensed community care facility. in a home or facility in accordance with the federal Indian Child Welfare Act. Placement with the child's relative, (name): has been independently considered by the court and is denied for the reasons stated on the record. The statutory preference order for placement in a suitable Indian home is modified for good cause as a. b. c. stated on the record. described in the social worker's report. Other (specify): 12. 13. 14. 15. The child's out-of-home placement is necessary. The child's current placement is appropriate. The child's current placement is not appropriate. The county agency must locate an appropriate placement for the child. a. b. The matter is continued to the date and time indicated in form JV-415, item 17 for a report by the county agency on the progress made in locating an appropriate place. Other (specify): written oral JV-421 [Rev. January 1, 2017] DISPOSITIONAL ATTACHMENT: REMOVAL FROM CUSTODIAL PARENT--PLACEMENT WITH NONPARENT (Welf. & Inst. Code, §§ 361, 361.2) Page 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com JV-421 CHILD'S NAME: CASE NUMBER: 16. The child is placed outside the state of California and that out-of-state placement a. b. continues to be the most appropriate placement for the child and is in the best interest of the child. is not the most appropriate placement for the child and is not in the best interest of the child. written The matter is continued to the date and time indicated in form JV-415, item 17 for a report by the county agency on the progress made toward (1) (2) (3) returning the child to California and locating an appropriate placement within California. locating an out-of-state placement that is the most appropriate placement for the child a
Link/Embed this Document
URL
Embed


Popular Searches

  1. appearance
  2. eviction
  3. small claims
  4. petition for termination of parental rights
  5. financial affidavit
  6. dissolution of marriage
  7. adoption
  8. civil cover sheet
  9. name change
  10. writ of execution

Bookmark and Share