IN THE JUVENILE COURT OF __________________________ COUNTY, GEORGIA IN THE INTEREST OF: ______________________________, An Unemancipated Minor CASE NUMBER _____________________ SEX _______________________________ DOB _______________ AGE ___________ CERTIFICATE I hereby certify that according to the record in this case, a hearing was scheduled to be heard on the ______ day of ________________________________, 20_____, at ____ o'clock ____.m. The hearing was not held because the petitioner failed to appear at the appointed time, and there was no motion for a continuance. The case was dismissed as evidenced by the Court Order attached hereto. This ____ day of _____________________________________, 20_____. _________________________________ Clerk or Designated Deputy (Seal of Court) Rev. 01/2001 JUV-29 American LegalNet, Inc. www.USCourtForms.com