Juvenile Petition Abuse Neglect Dependency
Juvenile Petition Abuse Neglect Dependency Form. This is a North Carolina form and can be use in Juvenile Statewide.
Tags: Juvenile Petition Abuse Neglect Dependency, J-130, North Carolina Statewide, Juvenile
File No. STATE OF NORTH CAROLINA In The General Court Of Justice District Court Division County IN THE MATTER OF: Name And Address Of Juvenile JUVENILE PETITION (ABUSE/NEGLECT/DEPENDENCY) Juvenile's Date Of Birth Age Sex Race G.S. 7B-101, -402 Condition Alleged Name Of Petitioner Abused Neglected Dependant I have sufficient knowledge or information to believe that a case has arisen that invokes the juvenile jurisdiction of the court, and therefore allege that: 1. The juvenile named above resides in the district at the address shown above, or was found in the district as alleged herein. 2. The information required by G.S. 50A-209 is set out in the Affidavit As To Status Of Minor Child (AOC-CV-609), which is attached hereto and incorporated herein by reference. 3. The names, addresses and telephone numbers of the juvenile's parents, guardian, custodian, or caretaker are as follows: NAME RELATIONSHIP OR TITLE ADDRESS TELEPHONE NO. 4. The juvenile is an abused juvenile, neglected juvenile, or dependent juvenile, as alleged more specifically below: (Check only the blocks that apply.) A. The juvenile is an ABUSED JUVENILE, in that the juvenile's parent, guardian, custodian or caretaker: 1. has inflicted or allowed to be inflicted on the juvenile a serious physical injury by other than accidental means. 2. has created or allowed to be created a substantial risk of serious physical injury to the juvenile by other than accidental means. 3. has used or allowed to be used upon the juvenile cruel or grossly inappropriate devices or procedures to modify behavior. 4. has committed, permitted, or encouraged the commission of a sex or pornography offense with or upon the juvenile in violation of the criminal law. 5. has created or allowed to be created serious emotional damage to the juvenile. 6. has encouraged, directed, or approved of delinquent acts involving moral turpitude committed by the juvenile. Specifically, on or about (date or time period) : (State facts supporting allegations that the juvenile is an abused juvenile as indicated above. Attach additional pages if necessary.) AOC-J-130, Rev. 9/10 (Replaces J-100) © 2010 Administrative Office of the Courts (See reverse side for Additional Allegations) American LegalNet, Inc. www.FormsWorkFlow.com B. The juvenile is a NEGLECTED OR SERIOUSLY NEGLECTED JUVENILE, in that the juvenile: 1. does not receive proper care, supervision, or discipline from the juvenile's parent, guardian, custodian, or caretaker. 2. has been abandoned. 3. is not provided necessary medical care. 4. is not provided necessary remedial care. 5. lives in an environment injurious to the juvenile's welfare. 6. has been placed for care or adoption in violation of law. Specifically, on or about (date or time period) : (State facts supporting allegations that the juvenile is a neglected juvenile as indicated above. Attach additional pages if necessary.) C. The juvenile is a DEPENDENT JUVENILE, in that: 1. the juvenile needs assistance or placement because the juvenile has no parent, guardian, or custodian responsible for the juvenile's care or supervision. 2. the juvenile's parent, guardian, or custodian is unable to provide for the juvenile's care or supervision and lacks an appropriate alternative child care arrangement. Specifically, on or about (date or time period) is a dependent juvenile as indicated above. Attach additional pages if necessary.) : (State facts supporting allegations that the juvenile 5. Each parent, guardian, custodian or caretaker named below abused or seriously neglected the juvenile as alleged more fully in paragraph 4.A, or 4.B above, and is a responsible individual as defined in G.S. 7B-101(18a) (list persons alleged to be responsible individuals.) 1. 2. 3. I request the Court to hear the case to determine whether the allegations are true and whether the juvenile is in need of the care, protection, or supervision of the State. VERIFICATION Being first duly sworn, I say that I have read this Petition and that the same is true to my own knowledge, except as to those matters alleged upon information and belief, and as to those, I believe it to be true. Signature Of Petitioner SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Date Signature Of Person Authorized To Administer Oaths Deputy CSC Assistant CSC Clerk Of Superior Court Director Authorized Representative of Director County Department of Social Services Address Date My Commission Expires Notary City, State, Zip Telephone No. County Where Notarized SEAL Witness(es) Name AOC-J-130, Side Two, Rev. 9/10 (Replaces J-100) © 2010 Administrative Office of the Courts Address Telephone No. American LegalNet, Inc. www.FormsWorkFlow.com