COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DEPENDENCY-NEGLECT & FINS 1 6/1/2017 This juvenile cover sheet is required by Supreme Court Administrative Order 8. 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. Instructions are located . County: District: Filing Date: Judge: Division: Case ID: Case Type (choose only one IF a new case): Juvenile 1 Juvenile 2 Last Name Last Name Suffix Suffix First Name First Name Middle name Middle name DL/State ID / Contexte ID DL/State ID / Contexte ID SSN SSN Date of Birth Date of birth Sex Male Female Sex Male Female Ethnicity Hispanic Non - Hispanic Ethnicity Hispanic Non - Hispanic Race Race Removal date Removal date Education Plan IEP 504 N/A Education Plan IEP 504 N/A School status School status Interpreter needed? Yes: No other language: Interpreter needed? Yes: No other language: Case IDs of other cases involving this/these juvenile(s): Petitioner If a school representative is the affiant or petitioner, school name: Petitioner (if school representative or other adult) Relationship to child(ren) Phone Last Name Email Suffix Self - represented Yes No First Name DOB DL/State ID Interpreter needed? Yes: No other language: Address City, State ZIP American LegalNet, Inc. www.FormsWorkFlow.com COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DEPENDENCY-NEGLECT & FINS 2 6/1/2017 Attorney of Record: Bar #: For the: Petitioner Juvenile Parent Intervenor Email Address: Parent/Guardian 1 Parent/Guardian 2 Last Name Last Name Suffix Suffix First Name First Name Middle Name Middle Name DL/StateID/ Contexte ID DL/StateID/ Contexte ID Address Address City, State ZIP City, State ZIP Phone Phone Email Email SSN SSN Date of Birth Date of Birth Interpreter needed? Yes: No other language: Interpreter needed? Yes: No other language: Parent of All Only this child(ren): Parent of All Only this child(ren): Manner of filing: (MFO) Original Re-Open (MFT) Transfer If r eopen or p etition in e xisting c ase , select the type of petition: American LegalNet, Inc. www.FormsWorkFlow.com