File No. Name And Address Of JuvenileJuvenile222s Date Of Birth Date Of HearingAgeJUVENILE LEVEL 1DISPOSITION ORDER (DELINQUENT)G.S. 7B-2500, -2501, -2502, -2506 through -2510, -2512The following persons were present at the hearing: STATE OF NORTH CAROLINA CountyIn The General Court Of JusticeDistrict Court Division IN THE MATTER OF FINDINGS The most serious offense before the Court today, which provides the basis for disposition, is: Adjudication DateF/MClassOffense (with statute number) Based on the evidence presented, the Court makes the following Findings of Fact:1. � The juvenile delinquency history level is � low (0-1 point). � medium (2-3 points). � high (4+ points).2. � The Court received and considered � predisposition report � risk assessment � needs assessment and � incorporates the contents of � predisposition report � risk assessment � needs assessment by reference. � (If the report is incorporated, a copy of the report MUST be attached to the order.)3. � Other Findings: (continue on attached page(s) if necessary) NOTE: � is ordering restitution. CONCLUSIONS OF LAW (check only one block) 1. � The Court is required to order a Level 1 disposition. 2. � The Court is required to order either a Level 1 disposition or a Level 2 disposition, and is entering a Level 1 disposition.The disposition ordered below is authorized by law and is an appropriate plan to meet the needs of the juvenile and to achieve the objective of the State in exercising jurisdiction.(Over) NameNameRelationship/TitleRelationship/Title American LegalNet, Inc. www.FormsWorkFlow.com ORDER It is ORDERED that: (Select and check appropriate disposition(s). If necessary, attach additional page and reference appropriate paragraph(s).)LEVEL 1. COMMUNITY DISPOSITIONS � 1. � Probation [G.S. 7B-2506(8)]. The juvenile be placed on probation, under the supervision of a court counselor, for (period of time, not to exceed one year) , under the conditions listed on the attached 223Supplemental Order Conditions Of Probation (Delinquent)224 (AOC-J-464). � � a. � Ordered for months and days, or until (specify date) . � � b. � Continued as previously ordered on (specify date) . � � c. � Extended from (specify date) for months and days, or until (specify date) . � 2. � In-Home Supervision With Conditions [G.S. 7B-2506(1)a]. The juvenile remain at home and be supervised by � , subject to the following conditions applicable to the parent, � 3. � Custody [G.S. 7B-2506(1)b]. The juvenile is hereby placed in the custody of: � The juvenile222s parents The juvenile222s mother The juvenile222s father Other: (specify person or agency and relationship � � � The County Department of Social Services, as the Court finds that the juvenile222s continuation in the juvenile222s home would be contrary to the juvenile222s best interest, as evidenced by � � . � The County Department of Social Services was notified and given an opportunity to be heard prior to the Court placing the juvenile in the agency222s custody. � The Court also finds that: � Efforts to prevent the need for the juvenile222s placement were precluded by an immediate threat of harm to the juvenile, and placement of the juvenile in the absence of such efforts was reasonable. The immediate threat of harm was � . � � The County Department of Social Services made reasonable efforts to prevent the need for the juvenile222s placement, namely: � . � � The County Department of Social Services did not make reasonable efforts to prevent the need for the juvenile222s placement. � This placement shall be reviewed in accordance with G.S. 7B-906.1. � 4. � Excuse From School Attendance [G.S. 7B-2506(2)]. The juvenile is excused from compliance with the compulsory school attendance law and shall comply instead with the following plan: � 5. � [G.S. 7B-2506(3)]. The juvenile cooperate with the following (specify time, not to exceed one year) : � � a. � community-based program � � . � � b. � intensive substance abuse treatment program � � . � � c. � residential treatment program � � . � � d. � nonresidential treatment program � � .(Over) American LegalNet, Inc. www.FormsWorkFlow.com � 6. � Restitution [G.S. 7B-2506(4)]. (up to $500) The juvenile pay restitution in the amount of (Specify amount, not to exceed $500. If $ of (name payee) � , payable within (specify time, not to exceed 12 months) , according to the following terms and conditions: (NOTE: ) � 7. � Payment of Fineadult for same offense) $ � 8. � Community Service [G.S. 7B-2506(6)].The juvenile perform hours (not to exceed 100) of community service, as follows: (specify nature of work and length of obligation, not to exceed 12 months) � 9. � Victim-Offender Reconciliation [G.S. 7B-2506(7)]. The juvenile must participate in a victim-offender reconciliation program. � 10. � No Drivers License [G.S. 7B-2506(9)]. The juvenile not be licensed to operate a motor vehicle in this state: � a. for (specify period of time) � . � b. for as long as the Court retains jurisdiction, and that the Clerk notify the Division of Motor Vehicles of this Order. NOTE TO CLERK: . � 11. � Curfew [G.S. 7B-2506(10)]. The juvenile comply with the following curfew: � 12. � [G.S. 7B-2506(11)]. The juvenile not associate with: (specify person(s)) � 13. � [G.S. 7B-2506(11)]. The juvenile not be in the following place(s): � 14. � facility, as follows: � 15. � [G.S. 7B-2506(13)]. The juvenile cooperate with placement in a wilderness program. NOTE: This is both a Level 1 and a Level 2 disposition. IN THE MATTER OF File No. Name Of Juvenile(Over) American LegalNet, Inc. www.FormsWorkFlow.com � 16. � Interdisciplinary Evaluation [G.S. 7B-2502(c)]. The local management entity director (formerly, area mental health, developmental disabilities, and substance abuse services director) arrange an interdisciplinary evaluation of the juvenile, mobilize resources, and take other appropriate action to meet the juvenile222s needs, and report to the Court; further, that the Clerk mail a copy of this Order to the local management entity director (formerly, area mental health director). NOTE TO CLERK: � 17. � [G.S. 7B-2502(a)]. The juvenile be tested for the use of controlled substances, and that the results of this initial test be used for evaluation and treatment purposes only. � 18. � [G.S. 7B-2502(a)]. The juvenile be tested for the use of alcohol, and that the results of this initial test be used for evaluation and treatment purposes only. � 19. � Requirements For Parent, Guardian, Custodian [G.S. 7B-2700 through -2704]. The juvenile222s mother father guardian custodian comply with the 223Supplemental Order To Parent, Guardian Or Custodian Of Undisciplined Or Delinquent Juvenile224 (AOC-J-463) directed to that person, which is attached and incorporated by reference. � 20. � This case be brought back before the Court for review on (specify date or time period) � . � 21. � Expunction The Court informed the juvenile about the expunction of juvenile records as provided for in G.S. 7B-3200, if applicable. � 22. � Other (attach additional sheet if necessary):EVALUATION AND TREATMENT OTHER Date American LegalNet, Inc. www.FormsWorkFlow.com