INFORMAL ADJUSTMENT AGREEMENT IN THE JUVENILE COURT OF ____________________________ COUNTY, GEORGIA In the interest of: CASE NUMBER _____________________ SEX _______________________________ _________________________________, DOB _____________ AGE ____________ The above-named child having been charged with and;The child and his parent/guardian having acknowledged the following: (1) That the admitted facts bring the case within the jurisdiction of the Court; (2) That the child has been advised that he/she has a right to have an attorney represent him/her in this matter and that if he/she is unable to afford to hire an attorney, one will be supplied free of charge; (3) That he/she does not have to make any statement if he/she chooses not to; (4) That this matter could be heard formally before a judge rather than by an officer of the Court. The child and parent do hereby elect to have an attorney ____ not to have an attorney ____ and to proceed with this informal handling. _______________________________ _________________________________ Signature of Child Signature of Parent/Guardian _______________________________ _________________________________ Date Date This Court having determined that the above-named child is subject to the jurisdiction and protection of this court as provided by law, and; This Court having found that counsel and advice without an adjudication is in the best interest of the public and the child, and; The child and his/her parent(s) or guardian having consented to the informal adjustment with knowledge that consent is not obligatory. It is therefore agreed that the case of the above-named child is informally adjusted under the conditions and stipulations attached hereto and incorporated in this informal adjustment by reference. Rev. 01/2001 JUV-17>>>> 2Further, the above-named child and his/her parent(s) or guardian acknowledge that they have been advised, by a copy of this informal adjustment, and agree that any violation of any provision of this adjustment may result in the filing of a petition at any time during the term or period of this informal adjustment or any extension thereof. Consented to by: Recommended by: _____________________________ ________________________________ Child Officer of Juvenile Court _____________________________ Parent/Guardian _____________________________ Attorney Approved, this ________ day of _______________________________, 20_____. _____________________________________ Judge/Associate Judge of _______________________ County Juvenile Court Rev. 01/2001 JUV-17