ADJUDICATION/DISPOSITION REPORTING FORM STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DEPENDENCY & DEPENDENCY-NEGLECT 1 /1/2017 This disposition form 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 Represe nting Adjudication Date (HA43T): Disposition Date (HD80): Manner of Disposition (if not the same for all children, use page 2 and leave this blank) Trial type (B) Bench Trial (N) Non - Trial (P) Stipulation Manner of Disposition (choose 1) If consolidated, case ID: Placement outcome (JVDN) (choose 1) Is this case set for review? Yes (MSSD) No (JUC0) (No indicates that the case is closed.) Date & Time of Review Hearing: Was an interpreter used for this case? Yes No For whom? Language: Other: Was any party self-represented for the adjudication or disposition? Yes No If so, who? If this case 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 ADJUDICATION/DISPOSITION REPORTING FORM STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DEPENDENCY & DEPENDENCY-NEGLECT 2 /1/2017 Supplemental juvenile information Use if the outcome was different as to different children. Use an additional page if necessary. 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) If consolidated, case ID: Manner of Disposition (choose 1) If consolidated , case ID: Placement outcome (JVDN) (choose 1) Placement outcome (JVDN) (choose 1) Juvenile 3 Juvenile 4 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) If consolidated, case ID: Manner of Disposition (choose 1) If consolidated, case ID: Placement outcome (JVDN) (choose 1) Placement outcome (JVDN) (choose 1) American LegalNet, Inc. www.FormsWorkFlow.com