COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : PETITION : (DEPRIVATION) Plaintiff(s) -against- Index No. Calendar No. JUDICIAL SUBPOENA : IN THE JUVENILE COURT OF __________________________ COUNTY, GEORGIA : In the interest of : _______________________________ SEXDefendant(s) ____ AGE _____ DOB _________ CASE # ________________ : ...................................................... _______________________________ SEX ____ AGE _____ DOB _________ CASE # ________________ _______________________________ SEX ____ AGE _____ DOB _________ CASE # ________________ _______________________________ SEX ____ AGE _____ DOB _________ CASE # ________________ THE PEOPLE OF THE STATE OF NEW YORK A child/children under 18 years of age. TO Your petitioner alleges the child(ren) named above to be of the sex(es) and age(s) and to have the name(s) there set forth above; that the (putative) father of said child(ren) is __________________________, who resides at ___________________________________________________________________; the mother is _____________________________, who resides at __________________________________________; said GREETINGS: child(ren) reside(s) at ________________________________________________________________, in said WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before county and state, and is/are in the custody and control of _________________________, who resides at said , the Honorable said child(ren) is/are subject to the jurisdiction of this Court; that said child(ren) is/are in need of at the Court place; that the located at County of of this Court and is/are deprived (O.C.G.A. §15-11-2(8)) due to the following condition(s): protection in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on theof O.C.G.A. §15-11-45(a)(4). part of the That said child(ren) was/were (not) taken into custody under the provisions That it is in the best interest of the child(ren) and the public that this proceeding be brought. That said child(ren) is/are, is not/are not currently in shelter care facilities under the supervision of the ______________________________________ County Department of Family and Children Services, having Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to been placed there at ____m., on ____________________________________, 20_____. the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a resultPetitioner prays to comply. issue, directed to the parties hereto, requiring them to appear before this Court of your failure that process to answer the allegations of this petition. Witness, Honorable Court in County, , one of the Justices of the ___________________________________ day of , 20 (Petitioner) Subscribed and sworn to before me, on information and belief this ______________ day of _________________________________, 20_____. (Attorney must sign above and type name below) ___________________________________ (Attesting Officer) Attorney(s) for The above petition is approved to be filed in the best interest of the public and the named child(ren). This ______ day of ______________________________, 20______. Office and P.O. Address Rev. 01/2001 __________________________________ (Court Designee) Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: JUV-4 American LegalNet, Inc. www.USCourtForms.com