Approved, SCAO STATE OF MICHIGAN CASE NO. JUDICIAL CIRCUIT - FAMILY DIVISION DIVERSION RECORD PETITION NO. COUNTY Court address Court telephone no.1. Minors name Date of birth Minors address Fathers name Fathers address Mothers name Mothers address Alleged offense for which minor was apprehended Date and place of alleged offense 2. The following factors have been examined in connection with this case. a. the nature of the alleged offense, b. the minors age, c. the nature of the problem that led to the alleged offense, d. the minors character and conduct, and e. the minors behavior in school, family, and group settings. 3. The minor has not been previously diverted. satisfactory. The minor has been previously diverted. The minors compliance on the prior referral was unsatisfactory. 4. A conference has been held to consider diversion alternatives. released. 5. The minor was referred to the program located at .Date Agency Signature of intake worker or law enforcement official Address Name (type or print) City, state, and zip 6. Date: Compliance with the diversion agreement to date has been satisfactory. unsatisfactory. Signature Do not write below this line - For court use only JC 55 (6/03) DIVERSION RECORD MCL 722.821 et seq., MCR 3.932(A)