_________ COUNTY JUVENILE COURT FILED IN THE CLERKS OFFICE ON _____ DAY OF ______________. 20____ __________________________________ DEPUTY CLERK IN THE JUVENILE COURT OF _____________ COUNTY STATE OF GEORGIA IN THE INTEREST OF: __________________________ SEX: ___ DOB: __________ CASE # ___________________ __________________________ SEX: ___ DOB: __________ CASE # ___________________ __________________________ SEX: ___ DOB: __________ CASE # ___________________ __________________________ SEX: ___ DOB: __________ CASE # ___________________ Child(ren) Under 18 Years of Age ORDER OF ADJUDICATION and DISPOSITION The above and foregoing matter came before the Court on __________________, for an Adjudicatory Hearing based upon a Petition filed by the Georgia Department of Human Resources by and through the ____________ County Department of Family and Children Services alleging the above named child(ren) to be deprived. Based upon the evidence presented, the Court makes the following Findings of Fact and Conclusions of Law by clear and convincing evidence. FINDINGS OF FACT 1. Present in Court were: ( ) Mother ( ) Attorney ( ) Father (Legal) ( ) Attorney (Putative) ( ) Attorney ( ) DFACS ( ) SAAG ( ) Other Petitioner ( ) Attorney ( ) Guardian ad Litem ( ) Other __________________________________________________________________________ The following interested part(y)(ies) was/were NOT present: _____________________________________ >>>> 2 2. The child(ren) is/are of the age and sex and has/have the name(s) set forth above. (The child(ren) is/are (a) resident(s) of Bartow County, Georgia.) (The child(ren) was/were physically present in this county at the time of the filing of the Petition.) 3. The mother of the child(ren), ______________________, was/was not present in Court for the hearing. She was notified of the proceedings by (personal service) (certified mail) (publication). (She was not notified tof he proceedings because ___________________________ _____________________________________________________________________________.) The (legal) (biological) (putative) father of the child(ren), __________________________, was/was not present in Court for the hearing. He was notified of the proceedings by (personal service) (certified mail) (publication). (Hwas not notified of the e proceedings because ________ _____________________________________________________________________________.) 4. (facts showing deprivation) 5. rts to prevent removal and make the child(ren)s return [Facts outlining the effo mentrts to prevent removal and make t [or facts showing that the Departhe child(ren)s return ment The Court finds that based upon the Affidavit of Efforts filed by the ____________ County Department of Family and Children Services attached hereto as Exhibit A and incorporated herein, said Department made reasble efforts to ona preserve and reunify the family prior to the placement of the child(ren) in foster care, to prevent or eliminate the need for removal of the child(ren) from the home and to make it possible for the child(ren) to return hom e. 6. The Court finds the gross income of the mother is $____________ per ___________. The Court finds the gross income of the (legal) (biological) (putative) father is $_____________ per ____________. >>>> 3 ( ) The Court (does) (does not) find facts regarding special circumstances pursuant to O.C.G.A. 19-6-15(c). ( ) Facts regarding special circumstances are as follows: _______________________ __________________________________________________________________ CONCLUSIONS OF LAW Based upon the above findings of fact, the Court concludes as follows: The Court has subject matter jurisdiction over this action and personal jurisdiction over the child(ren), mother and (legal) (biological) (putative) father. Venue is proper in this Court. This/These child(ren) is/are (a) deprived child(ren) as defined in O.C.G.A. Section 15-11- 2(8)(A) in that he/she/they is/are without proparental care or control, subsper istence, education as required by law, or other care or control necessary for his/her/their physical, mental or emotional health or morals. The causes the deprivaof tion as to the mother are: ( ) Physical abuse ( ) Sexual abuse ( ) Emotional abuse ( ) Neglect/Lack of Supervision ( ) Medical Neglect ( ) Neglect/Inadequate Housing ( ) Educational Neglect ( ) Substance Abuse by Parent ( ) Abandonment ( ) Mental/Physical Impairment of Parent ( ) Neglect/Failure to Provide adequate support for child(ren) due to unstable or irregular employment ( ) (Perpetration of) (Failure to Protect from) Domestic Violence ( ) Other __________________________________________________ The causes of deprivation as to the (legal) (biological) (putative) father are: ( ) Physical abuse ( ) Sexual abuse ( ) Emotional abuse ( ) Neglect/Lack of Supervision ( ) Medical Neglect ( ) Neglect/Inadequate Housing ( ) Educational Neglect ( ) Substance Abuse by Parent 3>>>> 4 ( ) Abandonment ( ) Mental/Physical Impairment of Parent ( ) Neglect/Failure to Provide adequate support for child(ren) due to unstable or irregular employment ( ) (Perpetration of) (Failure to protect from) Domestic Violence ( ) Other __________________________________________________ The _________ County Department of Family and Children Services made reasonable efforts to preserve and reunify the family prior to the placement of the child(ren) in foster care, to prevent or eliminate the need for removal of the child(ren) from the home and to make it possible for the child(ren) to return home. The reason(s) the child(ren) cannot be adequately and safely protected at home is/are ____________________________________________________ ______________________________________________________________________________ Therefore, continuation in the home would be contrary to the welfare of the child(ren) and removal of the child(ren) from the homein the best interest of the child(ren). is Any of the Findings of Fact herein which should have been properly classified by the Court as Conclusions of Law shall be considered as Conclusions of Law and any Conclusions of Law which should have been properly classified as Findings of Fact shall be considered as Findings of Fact. TEMPORARY DISPOSITION Temporary custody and control of the child(ren) is HEREBY AWARDED to the Georgia Department of Human Resources through the _____________ County Department of Fam