Form 132 (Rev.11/10) The Family Court of the State of Delaware In and For Petitioner Name Street Address New Castle Kent Sussex County PETITION FOR RESTITUTION FROM PARENTS/GUARDIANS v. Parent/Guardian DOB Name Street Address DOB File Number P.O. Box Number City/State/Zip Code P.O. Box Number Petition Number City/State/Zip Code Attorney Name Attorney Name If a hearing is scheduled in this matter, will Petitioner need an interpreter? Yes (If yes, specify language If a hearing is scheduled in this matter, will Parent/Guardian need an interpreter? Yes (If yes, specify language ) ) No No Petitioner alleges: 1) That , a minor, has been adjudicated delinquent on the charge of by disposition of the Court dated . (Attached) 2) That as a result of said actions by said minor, he/she has suffered a total monetary loss in the amount of $ . [See Exhibits] 3) That said minor child resided at the time of the incident with the parents/guardians and did intentionally or recklessly cause damage to and/or steal petitioner's property; and 4) That the parents/guardians knew of the child's delinquent behavior and failed to take reasonable measures to control the child, making the parents/guardians responsible pursuant to 10 Del. C. 1009(c)(6); 5) Petitioner has been unable to obtain any or all restitution from the defendant as follows: WHEREFORE petitioner prays that the Court order the named parents/guardians pursuant to 10 Del. C. 1009(c)(6) to make restitution to petitioner for said losses in the amount not to exceed $5,000.00. Dated: Petitioner/Attorney Address (if not stated above): American LegalNet, Inc. www.FormsWorkFlow.com