State of Alabama Unified Judicial S ystem JU-27 Sample Rev. 1/09 PERMISSION TO PHOTOGRAPH/ FINGERPRINT/COLLECT DNA Case Number IN THE ____________ COURT OF _____________ COUNTY, ALABAMA In the Matter of _____________________________________________________ , a child I hereby request permission to photograph fingerprint collect DNA from _________________________________ (name of child), for the following reason(s): _____________________________________________________________________________ _____________________________________________________________________________ ____________________________________________________________________________. If permission is granted by the court, the photographs fingerprints above-named child will be for criminal identification purposes. __________________________ Date DNA of the ________________________________ Name of Requestor _________________________________ Signature of Requestor ORDER Upon reviewing the request above, I GRANT DENY the request. _________________________________ Date ______________________________ Judge NOTICE OF PENALTY This is to notify you that Ala.Code 1975, § 12-15-135(f), provides that "any person who willfully violates this section, upon conviction thereof, shall be guilty of a Class A misdemeanor under the jurisdiction of the juvenile court." Ala.Code 1975, §12-15-135(d) American LegalNet, Inc. www.FormsWorkFlow.com