1. � In the matter of � name(s), alias(es), DOB en-US2. Date of birthen-US3. Sexen-US4. Raceen-US5. Member of or eligible for membership in Indian Tribeen-US6. Heighten-US7. Weighten-US8. Eye coloren-US9. Hair coloren-US10. School/Districten-US11. Municipality and county of legal residenceen-US en-US12. Brief statement of the allegations and basis for any request for court-ordered apprehension, including the citations anden-US date, time, and location of offense � Operator/Chauffeur driver license � Commercial driver license � No license � Vehicle type en-US13. Codefendant(s): name(s), alias(es), DOB en-US14. Parent222s nameen-USAddressen-USHome phoneen-USWork phoneen-US15. Parent222s nameen-USAddressen-USHome phoneen-USWork phoneen-US16. Stepparent222s nameen-USAddressen-USHome phoneen-USWork phoneen-US17. Guardian/Legal custodian222s nameen-USAddressen-USHome phoneen-USWork phoneen-US18. Divorced?en-US No � en-US Yesen-USDate of divorceen-USPlace of divorce:en-US(county, state)en-US19. Custody to: (Specify name and include address if not previously listed) � en-US20. Juvenile living with: (Specify name and relationship)en-US 21. en-USI REQUEST � a. � a petition be authorized. � b. � the court review the information and make an appropriate disposition. � � c. � an order be issued to apprehend the juvenile pending the preliminary hearing pursuant to MCR 3.933(B). � � permission to enter the premises at en-US en-US . � � d. � an order be issued to detain the juvenile pending the preliminary hearing pursuant to MCR 3.934(B). en-USI declare that this complaint has been examined by me and that its contents are true to the best of my information, knowledge,en-USand belief. en-USComplainant222s signatureen-USDateen-USPrint or type nameen-USAddress/Agencyen-USTelephone no.en-USBASIS FOR REQUEST en-USSOCIAL INFORMATION en-USREQUEST American LegalNet, Inc. www.FormsWorkFlow.com Complaint (Request for Action, Delinquency Proceedings) � (12/18) � Page of Case No. Petition No. en-US en-US22. Basis for apprehension by police without court order � The officer had reason to believe that because of the nature of the offense, the interest � of the juvenile or the interest of the public would not be protected by release of the � juvenile. � Parent/guardian/legal custodian could not be located or refused to take custody of the � juvenile. en-US 23. Check if applicableen-US Miranda warning given � en-US Attorney presenten-US Offense admitted � en-US Biometric data collecteden-US Offense denied � en-US Photograph takenen-US Parents/Guardian/Legal � en-US Line-up helden-US custodian present 24. � Release and recognizance en-US en-USI acknowledge that the juvenile has been released to my custody, and I promise to bring the juvenile to the court upon notice. en-USDateen-US en-USSignatureen-US en-USRelationship to juvenile 25. � I notified or attempted to notify the person(s) listed below about the date, time, and place of the preliminary hearing. The method of contact or attempted � contact is described below and includes the date and time of notification for each. en-US26. Name en-US notified en-US attempteden-USMethods useden-USDateen-USTimeen-US27. Name en-US notified en-US attempteden-USMethods useden-USDateen-USTimeen-US28. Name en-US notified en-US attempteden-USMethods useden-USDateen-USTimeen-US29. Name en-US notified en-US attempteden-USMethods useden-USDateen-USTimeen-US � en-USCUSTODY en-USFill out completely en-USNOTIFICATION TO PARENT, GUARDIAN, OR LEGAL CUSTODIAN en-USADDITIONAL COMMENTS American LegalNet, Inc. www.FormsWorkFlow.com