JD-1721, 11/18 Petition under Chapter 938 Delinquency, Protection or Services, Civil Law/Ordinances 247247938.25 and 938.255, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Amended Petition under Chapter 938 Delinquency (under age 17) Protection or Services (under age 18) Civil Law/Ordinances (under age 16) Case No. D.A. Case No. I STATE ON INFORMATION AND BELIEF THAT THE FOLLOWING IS TRUE: [If unknown or cannot be ascertained, so state] 1. Name Date of Birth Sex Female Male Race Height Weight Hair Color Eye Color Juvenile has previously been adopted? Yes No Parent Name and Address See attached for additional parties Parent Legal Status: Birth Adjudicated/Adoptive Presumed Alleged Unknown Paren t Name and Address See attached for additional parties Parent Legal Status: Birth Adjudicated/Adoptive Presumed Alleged Unknown Guardian Legal Custodian Foster Parent Spouse, if any. If none of preceding, nearest relative. [Name] [Address] Juvenile in temporary custody? No Yes: Date Time a.m. p .m. Where held Not disclosed threat of i mminent danger to juvenile/physical custodian. 2. If petit ion alleges jurisdiction under 247938.13(4), (6), (6m), or (7), Wis. Stats., answer the following: Juvenile is subject to federal Indian Child Welfare Act? (25 USC 2472471901 - 1963) No Undetermined (Explain: ) The Indian juvenile is currently placed in - home; therefore, the federal Indian Child Welfare Act does not apply . (For an Indian juvenile who is placed out - of - home, use the Indian Child Welfare Act version [IW - 1721] of this petition.) Name and Address of School Enrolled 3. Under section(s) , the juvenile is delinquent in need of protection or services, supervision, care or rehabilitation in violation of civil law and/or ordinances because: See attached American LegalNet, Inc. www.FormsWorkFlow.com JD-1721, 11/18 Petition under Chapter 938 Delinquency, Protection or Services, Civil Law/Ordinances 247247938.25 and 938.255, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 4. The juvenile is placed out-of-home. A. Placement in the home at this time is is not contrary to the welfare of the juvenile and the community. B. Reasonable efforts to prevent removal were [Complete one of the following] made by the department or agency responsible for providing services. made by the department or agency responsible for providing services, although an emergency situation resulted in immediate removal of the child from the home. not required under 247938.355(2d ) , Wis. Stats . 5. The person who took this juvenile into custody and the intake worker have made reasonable efforts to return the I request adjudication and entry of an appropriate dispositional order. District Attorney/Corporation Counsel/Petitioner Name of Petitioner Printed or Typed Title Date American LegalNet, Inc. www.FormsWorkFlow.com