JV-117 (Rev. 03/12/2014) PETITION FOR YOUNG ADULTPERMANENCY HEARINGS DOCKET NUMBER Trial Court of MassachusettsJuvenile Court Department In the Matter of: DIVISION(Date)(Signature of Agency Representative) Petition for Annual Permanency Hearings for Young AdultUnder the Responsibility of the Department of Children and FamiliesTo the Justices of the Juvenile Court.The Department of Children and Families represents:1. The young adult, , born on , is over theage of eighteen and currently resides in (type of placement) .(Print Name)(Address)2. The young adult was placed in the care and/or custody of the Department of Children and Families (alsoreferred to as "Department") under one of the following court proceedings:Care and Protection ofDocket No.Child Requiring Assistance (Child in Need of Services)Docket No.3. The young adult and the Department of Children and Families entered into an agreement for the Department tocontinue its responsibility to the young adult in accordance with G. L. c. 119, 247 23(f). As a result of the agreement,the young adult is under the responsibility of the Department.4. Chapter 119, section 29B requires the court to hold annual permanency hearings for young adults who areunder the responsibility of the Department pursuant to G. L. c. 119, 247 23(f).WHEREFORE, the petitioner, the Department of Children and Families, respectfully requests this court to scheduleand hold annual permanency hearings for the above named young adult as required pursuant to G. L. c. 119,247 29B. Telephone Number American LegalNet, Inc. www.FormsWorkFlow.com