Declaration Form In Support Of Access To And Copies Of Juvenile Records - Lasc Page 2

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C. Type of Records
Please check the box corresponding to the records you wish to access (check all that apply):
Juvenile Dependency - court file only
Juvenile Delinquency - court file only
Other (please specify below the type of records you seek, if not listed above)
________________________________________________________________________________________
If you are entitled and wish to access records from the Department of Child and Family Services (DCFS), please
contact Elo Ulloa or Marcy Stevenson – DCFS Records Unit/Office of County Counsel – address: 201 Centre
Plaza Dr Ste. 1, Monterey Park, CA 91754 – phone number: (323) 526-6100.
If you are entitled and wish to access records from the Probation Department, please contact the Custodian of
Records, Veronica Pawlowski, at (562) 940-2569.
D. Reason for Request of Records
Personal use
Other (please specify below if you plan to re-disclose records to third parties)
________________________________________________________________________________________
________________________________________________________________________________________
WARNING: Any records, reports or information obtained from the juvenile record(s) shall not be further released or
disseminated to persons or agencies not otherwise entitled to access pursuant to WIC §827, CRC Rule 5.552, and
LASC Local Rule 7.2 (i.e. agencies/individuals listed above). Further, juvenile records shall not be attached to any
documents without prior approval of the Juvenile Court Presiding Judge, unless they are used in connection with a
criminal investigation or juvenile court proceeding to declare a minor a dependent or ward of the Court.
I declare under penalty of perjury that the foregoing is true and correct and that I am aware of the above warning
regarding dissemination of juvenile records.
Date:
Signature:
Save
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JUV010 - Revised 2/2014
ARE YOU ENTITLED TO RECORDS?
(Are you a person/agency listed in Section A above?)
YES
NO
Do you want medical,
Do you have a court order allowing
psychological, and/or
you access to juvenile records?
educational records?
No
Yes
No
Yes
Will you be sharing the
You must file a
records with another person
petition under
File a Declaration
or agency?
to access records
WIC § 827.
and attach a copy
of the court order.
No
Yes
No - the records will
Are you sharing the records
be shared with a
with another person or
File a
person or agency that
agency that is entitled?
Declaration to
is NOT entitled.
access records
Yes

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