This government document is issued by Child Welfare Services for use in San Diego County, CA
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https://www.google.com/url?client=internal-element-cse&cx=015466730696295969998:wokiau6kw8k&q=https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/cs/cws/policies/adoptions/Placement%2520Paperwork%2520and%2520Finalization.pdf&sa=U&ved=2ahUKEwiVorDbg_X4AhXuCRAIHYPjCsYQFnoECAQQAg&usg=AOvVaw3qxewQgsD7kjaCUdLKIzdG