COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DELINQUENCY/EJJ This delinquency/EJJ cover 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. Instructions are located at www.courts.arkansas.gov. County: Judge: District: Division: Filing Date: Case ID: Case Type (select one): (JD) Delinquency (EJ) Extended Juvenile Jurisdiction Is this an amendment? Yes No If yes, reason: Does this juvenile have other active cases? Yes No Case IDs: Juvenile information Last Name Alias Suffix Address First Name Middle Name City Contexte ID State DLN/State ID ZIP SSN Custody date Date of Birth Arrest date Sex Male Female ATN Ethnicity Hispanic Non-Hispanic Was this a school-related arrest? Yes No Race Biracial School Status Under school age Check one Asian/Pacific Islander Check one Enrolled Home-schooled Black Truant/Not attending American Indian/Alaska Native Suspended Expelled Unknown Withdrawn GED obtained White Graduated High School Educational Accommodation Interpreter needed? IEP None 504 N/A Spanish Sign Language Other: Relationship Last Name Suffix First Name Middle Name DLN/State ID SSN Date of Birth Address City, State ZIP Email Interpreter needed? 1 Parent/Guardian 1 None Spanish Sign Lang. Other: Relationship Last Name Suffix First Name Middle Name DLN/State ID SSN Date of birth Address City, State ZIP Email Interpreter needed? Parent/Guardian 2 None Spanish Sign Lang. Other: 2/9/2017 American LegalNet, Inc. www.FormsWorkFlow.com COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DELINQUENCY/EJJ The offenses in the attached information include: Code # Offense name/Description A/S/C Offense Date Counts F/M Class Other Juveniles/Defendants: Related Case IDs: Attorney Providing Information: Email Address: Manner of filing (choose one): (MFO) Original Bar #: Phone: (MFRJD) Re-Open Delinquency (if so, why?): Probation revocation DYS Aftercare Violation (MFREJ) Re-Open EJJ (if so, why?): EJJ Review Hearing Contempt DYS Release Hearing (MFT) Transfer from another jurisdiction (MFTC) Transfer from Criminal Division to EJJ: date of transfer hearing: Was juvenile's attorney present? Yes No If a detention hearing related to this petition has already occurred, Date of detention hearing (HD60): Detention hearing outcome: Continue detention Release on personal recognizance Release to parent/guardian/custodian Release to qualified person/agency Reasonable restrictions Release upon order to appear Release upon bond Was juvenile's attorney present? Yes No 2 2/9/2017 American LegalNet, Inc. www.FormsWorkFlow.com