DISPOSITION SHEET FOR TPR/ADOPTION/GUARDIANSHIP/OTHER ACTION STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DEPENDENCY & DEPENDENCY-NEGLECT 1 /1/2017 This dependency/dependency-neglect information sheet is required by Supreme Court Administrative Order 8 to be completed and filed for every juvenile. The data contained herein shall not be admissible as evidence in any court proceeding or replace or supplement the filing and service of pleadings, orders, or other papers as required by law or Supreme Court rule. Case ID: Attorney Bar # Type Represen ting Hearing Date (HD80): Type of petition being disposed (choose one): Manner of Disposition Juvenile 1 Juvenile 2 Last name Last name First name First name MI MI Suffix Suffix Trial type (B) Bench Trial (N) Non-Trial (P) Stipulation Trial type (B) Bench Trial (N) Non-Trial (P) Stipulation Manner of Disposition (choose 1) ( MD D M ) Dismissed (MDPG) Granted (MDPD ) Denied Manner of Disposition (choose 1) ( MD D M ) Dismissed (MDPG) Granted (MDPD ) Denied Is this case set for review? Yes (MSSD) No (JUC0) (No indicates that the case is legally closed.) If yes, hearing date and time: Was an interpreter used for this case? Yes No For whom? Language: Other: Was any party self-represented for the hearing on this petition? Yes No If so, who? If this case is closed and involved custody or support (CSINF): Custody placed with: Child support ordered: New Modified Terminated N/A Person(s) ordered to pay child support: Was there an order of protection in this case? Yes No If yes, name of person(s) protected under the order: American LegalNet, Inc. www.FormsWorkFlow.com