Inmate Visiting Guidelines Attachment 2

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_________________________________________________________________________________________

WrittenConsentforMinorVisitation

I,(Parent/LegalGuardian)givepermissionfor:

NAME:____________________________________________________AGE:_____________________DOB:________________

NAME:____________________________________________________AGE:_____________________DOB:________________

Tovisit(InmateNameandCDCRNumber)______________________________________________________ataCaliforniaState

PrisonorInstitution.

With(NameofAccompanyingAdult)_____________________________________________________________________forone

year.Iunderstandthis AuthorizationistobeupdatedannuallyandthattheminorBirthCertificate,oraCertifiedCopyoftheBirth

Certificate,fromtheCountyRecorder’s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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Acknowledgement

Anotarypublicorother officercompletingthiscertificateverifiesonlythe identityoftheindividualwhosigned the document,to

whichthiscertificateisattached,andnotthetruthfulness, accuracy,orvalidityofthatdocument.

StateofCaliforniaCountyof____________________________________________________On,(Date)_____________________

beforeme,(NameandTitleofOfficer)_________________________________________________________personallyappeared.

(NameParent/LegalGuardian)_____________________________________________________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 acknowledge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.

WITNESSmyhand andofficialseal.

Signature_______________________________________________________(PlaceNotarySeal/Stampintheareaabove)

From Visiting a Friend or Loved One in Prison (Attachment 2)