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Get CA SOC 834 2013

When a court of competent jurisdiction has determined that the suspected abuse or severe neglect has occurred, or when the allegation of child abuse or severe neglect resulting in the referral to the Child Abuse Central Index is pending before the court. A. CONTACT INFORMATION DATE OF BIRTH NAME: STREET ADDRESS: CITY: STATE: TELEPHONE NUMBER: ALTERNATE NUMBER: ( ( ) ZIP CODE: ) I hereby request a grievance hearing to dispute the decision to list my name on the Child Abuse Central Ind.

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