State of Alabama Unified Judicial System Case Number COMPLAINT (Affidavit) Form JU-2 Rev. 10/11 IN THE JUVENILE COURT OF COUNTY, ALABAMA IN THE MATTER OF A CHILD: Child’s Name: ______________________________________ AKA: _________________ Race: _______ Sex: _______ Address: ________________________________________________________________ Phone: __________________ Date of Birth: _____________ Height: _________ Weight: _________ Eyes: ______________ Hair: _______________ SSN: ______________________School: ________________________________________ Grade: _________________ Father: ________________________________________ Home Phone: _____________ Work Phone: _____________ Address: ______________________________________________________________ Alt. Phone: _____________ Mother: ________________________________________ Home Phone: _____________ Work Phone: _____________ Address: ______________________________________________________________ Alt. Phone: _____________ Lives with: _____________________________________ Relationship: ______________ Home Phone: _____________ Address: ______________________________________________________________ Alt. Phone: _____________ Legal Guardian: _________________________________ Relationship: ______________ Home Phone: _____________ Address: ______________________________________________________________ Alt. Phone: _____________ Alleged Violation or Incident: __________________________________________ Date of Occurrence: ______________ Place of Occurrence: ________________________________________________________________________________ Category: Delinquency Dependency Child in Need of Supervision (CHINS) Violation of Probation/Aftercare Agency (if applicable): _________________________________________Agency Case Number: ___________________ Documents attached and incorporated into this Complaint by reference: (check all that apply) Incident/Offense Report Supplemental I/O Report Arrest Report Traffic Ticket/Complaint (UTTC) Additional Pages Other: (describe) _______________________________________________________ Facts of Violation/Incident: (For a delinquency or CHINS complaint, include the date, time, place, co-defendants and ages, victim information, approximate value of property taken/damaged/received, and description of the specific offense committed. For a dependency complaint, identify the abuse, neglect or inadequate care suffered by the child, the place of the abuse or neglect or inadequate care, the extent of any injury, the name and relationship of the person responsible for the abuse, neglect or inadequate care of the child. State actions taken or reasons for taking the child into custody, if applicable.) __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Complainants Name: (printed)_______________________________________________ Phone: ____________________ Address or Agency: ________________________________________________________________________________ I swear or affirm that I have knowledge of the facts set forth in this Complaint or am informed of them and believe that they are true. Further, I agree to sign a formal petition and testify in court if necessary to substantiate this complaint. Complainant’s Signature: ________________________________________________ Date: _______________________ SWORN TO AND SUBSCRIBED BEFORE ME: ____________________ ______________________________________ Intake Officer or Notary Public Date TO BE COMPLETED BY INTAKE OFFICER I have examined the information provided above and determined that subject matter jurisdiction venue probable cause IS/ARE NOT legally sufficient to warrant the receipt of this complaint as provided for in Rule12, Ala.R. Juv.P. I have examined the information provided above and determined that subject matter jurisdiction, venue and probable cause, as alleged, ARE legally sufficient to warrant the receipt of this complaint as provided for in Rule 12, Ala.R.Juv.P. Complaint Denied/Received: _______________ Date _________ Time ___________________________________________ Intake Officer ACTION TAKEN: ___________________________________________________________________________________ Rule 12, Ala.R.Juv.P.; Ala. Code 1975, §§12-15-118(1), 12-15-120(a) American LegalNet, Inc. www.FormsWorkFlow.com