File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Court Division IN THE MATTER OF: Name And Address Of Juvenile EX PARTE ORDER TO CEASE OBSTRUCTION OF Date Of Birth Age OR INTERFERENCE WITH JUVENILE INVESTIGATION Name Of Petitioner G.S. 7B-303 Name And Address Of Respondent 1 Name And Address Of Respondent 2 PROBABLE CAUSE FINDING From the verified petition filed in this matter and from the Courts inquiry of the Director or other representative of the Department of Social Services (DSS) of the county named above, The Court finds probable cause to believe that: 1. the juvenile named above is at risk of immediate harm and 2. the respondent(s) named above is/are obstructing or interfering with the Directors or other Social Services representatives ability to investigate to determine the juveniles condition. Therefore, pursuant to G.S. 7B-303, the Court enters this Order, which is intended to be limited to provisions necessary to enable DSS to conduct an investigation sufficient to determine whether the juvenile is in need of immediate protection or assistance. ORDER It is hereby ORDERED AND DECREED that: 1. The respondent(s) named above: a. disclose to the DSS the whereabouts of the juvenile named above. b. allow representatives of the DSS personal access to the juvenile. c. allow representatives of the DSS to observe and interview the juvenile in private. d. allow representatives of the DSS access to the following information/records: . e. allow the DSS to arrange for an evaluation of the juvenile by a physician or other expert. f. Other: . 2. A hearing in this matter be held within ten (10) days to determine whether there is good cause for the continuation of this Order or the entry of a different order. 3. This Order, along with a copy of the petition, summons, and notice of hearing, be served on respondent(s) named above; on the juveniles parent, guardian, custodian, or caretaker, and on (name anyone else the Court deems to be a necessary party) .Date Name Of District Court Judge (Type Or Print) Signature Of District Court Judge AOC-J-122, New 7/99 1999 Administrative Office of the