PETITION (DEPRIVATION) IN THE JUVENILE COURT OF __________________________ COUNTY, GEORGIA In the interest of _______________________________ SEX ____ AGE _____ DOB _________ CASE # ________________ _______________________________ SEX ____ AGE _____ DOB _________ CASE # ________________ _______________________________ SEX ____ AGE _____ DOB _________ CASE # ________________ _______________________________ SEX ____ AGE _____ DOB _________ CASE # ________________ A child/children under 18 years of age. 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 child(ren) reside(s) at ________________________________________________________________, in said county and state, and is/are in the custody and control of _________________________, who resides at said place; that the said child(ren) is/are subject to the jurisdiction of this Court; that said child(ren) is/are in need ofprotection of this Court and is/are deprived (O.C.G.A. 15-11-2(8)) due to the following condition(s): That said child(ren) was/were (not) taken into custody under the provisions of O.C.G.A. 15-11-45(a)(4). 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 been placed there at ____m., on ____________________________________, 20_____. Petitioner prays that process issue, directed to the parties hereto, requiring them to appear before this Courtto answer the allegations of this petition. ___________________________________ (Petitioner) Subscribed and sworn to before me, on information and belief this ______________ day of _________________________________, 20_____. ___________________________________ (Attesting Officer) The above petition is approved to be filed in the best interest of the public and the named child(ren). This ______ day of ______________________________, 20______. __________________________________ (Court Designee) Rev. 01/2001 JUV-4