Approved, SCAO . . . . . . . . . . . .STATE. OF. MICHIGAN ..... .. ........ : Index No. COUNTY : Plaintiff(s) ainst- Calendar No. : Court address JUDICIAL SUBPOENA Police agency report no. ORI MI- CASE NO. PETITION NO. PETITION Supplemental JUDICIAL CIRCUIT - FAMILY DIVISION CTN Court telephone no. TCN SID : 1. In the matter of DLN (name(s), alias(es), date(s) of birth) : : 2. The above named minor(s) come(s) within the provisions of MCL 712A.2. Citations and allegations: juvenile has violated probation as follows: Defendant(s) : ............................. E OF NEW YORK See attached sheet for further allegations. Member of or eligible for membership in American Indian Tribe or Band, state above. 3. An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor has been previously filed in Court, Case Number , was assigned to Judge , and remains is no longer pending. 4. I designate this case as a case in which the juvenile is to be tried in the same manner as an adult. 5. The above named minor(s) is/(are) resident(s) of County, and reside(s) in . U, that allthe care and custody of business and excuses being laid aside, you and each of you attend before 6. The names and addresses of the parents, guardians, legal custodians, or nearest known relative are as follows: , at the Court located at NAME day of , 20 , at o'clock in the noon, and ADDRESS at any recessed Father Putative give evidence as a witness in this action on the part of the HOME PHONE WORK PHONE Mother Guardian/Legal custodian/Nearest known relative y with this subpoena is punishable as a contempt of court and will make you liable to subpoena was issued for a maximum penalty of $50 and all damages sustained as a 7. I request the court to: (check either box a or b) . a. review the information and make an appropriate decision. b. authorize this petition and , one of the Justices of the 1) issue an order detaining the juvenile. removing the child the abuser from the home. 2) terminate mother's parental rights. father's parental rights. day of , 20 3) find the minor in contempt of court for violating a minor personal protection order. 4) find the juvenile has violated probation and notify juvenile to appear for hearing. order juvenile apprehended and brought to court for a detention hearing. (Attorney must case in which the juvenile is 5) designate this case as a sign above and type name below) to be tried in the same manner as an adult. I declare that the statements in this petition are true to the best of my information, knowledge, and belief. Petitioner's signature Attorney(s) for Print or type name Date Agency/Address City, state, and zip 8. A preliminary inquiry and/or hearing has been conducted and the filing of this petition Telephone no. is is not authorized. Office and P.O. Address Judge/Referee Date Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: JC 04 (6/03) PETITION Bar no. Do not write below this line - For court use only MCL 600.2950h-600.2950m, MCL 712A.2, MCL 712A.2d, MCL 712A.2h, MCL 764.15b, MCR 3.903(A)(19), MCR 3.931, MCR 3.961, MCR 3.983 American LegalNet, Inc. www.USCourtForms.com