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Get CA Written Consent for Minor Visitation

WRITTEN CONSENT FOR MINOR VISITATION AUTHORIZATION FORM I give permission for Parent/Legal Guardian NAME AGE DOB To visit Inmate at a California State Prison or institution Inmate Name and CDCR Number with for one year. I understand this Authorization is to be updated Name of Accompanying Adult annually and that the minor Birth Certificate or a Certified copy of the Birth Certificate from the County Recorders Office is required* Satisfactory Evidence of Proof of legal guardianship to said minor s is required as an attachment to this authorization form* I understand that this authorization can only be revoked IN WRITING and will remain in effect for one 1 year or until written notice of revocations is issued by the California Department of Corrections and Rehabilitation* Signature of Parent/Legal Guardian Date CERTIFICATE OF ACKNOWLEDGMENT State of California County of Here Insert Name and Title of the Officer who proved to me on the basis of satisfactory evidence to be the person s whose name s is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity ies and that by his/her/their signature s on the instrument the person s or the entity upon behalf of which the person s acted executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. I understand this Authorization is to be updated Name of Accompanying Adult annually and that the minor Birth Certificate or a Certified copy of the Birth Certificate from the County Recorders Office is required* Satisfactory Evidence of Proof of legal guardianship to said minor s is required as an attachment to this authorization form* I understand that this authorization can only be revoked IN WRITING and will remain in effect for one 1 year or until written notice of revocations is issued by the California Department of Corrections and Rehabilitation* Signature of Parent/Legal Guardian Date CERTIFICATE OF ACKNOWLEDGMENT State of California County of Here Insert Name and Title of the Officer who proved to me on the basis of satisfactory evidence to be the person s whose name s is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity ies and that by his/her/their signature s on the instrument the person s or the entity upon behalf of which the person s acted executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. .

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