6 Rule 8.33 — Form 1 February 2002 IN THE IOWA DISTRICT COURT FOR ________________________ COUNTY JUVENILE COURT IN RE THE FAMILY OF ________________________________; JUVENILE NO. ____________________ UPON THE PETITION OF ________________________________ A CHILD/CHILDREN or A PARENT, GUARDIAN or CUSTODIAN PETITION FOR FAMILY IN NEED OF ASSISTANCE The petitioner respectfully states to the court that [child/children] and [parent, guardian or custodian] are a family in need of assistance within the purview of Iowa Code sections 232.122 through 232.127, in that there has been a breakdown in the familial relationship. In support thereof, petitioner states as follows: [STATE BRIEFLY FACTS RELIED ON TO SUSTAIN PETITION.] Petitioner has sought services from ___________________________, a private or public agency, to maintain and improve the familial relationship, but the relationship has not improved and petitioner now requests the aid of the court. The name(s) and residence(s) of the child/children are _________________________________________________. The age(s) of the child/children is/are _____________________________________________________________. The names and residences of the living parents, guardian or custodian are __________________________________. The name and address of the guardian ad litem are _________________________________________________. WHEREFORE, the undersigned prays that the court set a time and place for hearing on the petition, appoint counsel for the child, order that notice be directed to all parties in interest in a manner provided by law, and upon hearing adjudicate this family to be a family in need of assistance and make such order or orders as may maintain and improve the familial relationship. __________________________________________________ Petitioner __________________________________________________ Address VERIFICATION State of Iowa ss County I, _________________________, being duly sworn, depose and say that I have read and signed the foregoing petition and that the allegations therein made are true to the best of my information and belief. __________________________________________________ Petitioner Subscribed and sworn to before me this _______________ day of ______________________, 20 _____. __________________________________________________ Notary Public or Deputy Clerk American LegalNet, Inc. www.FormsWorkflow.com