en-USFile No. en-USName And Address Of Juvenileen-USJUVENILE PETITIONen-US(ABUSE/NEGLECT/DEPENDENCY) en-USSTATE OF NORTH CAROLINAen-US en-US Countyen-USIn The General Court Of Justiceen-USDistrict Court Divisionen-USIN THE MATTER OF en-USName Of Petitioneren-USCondition Allegeden-USJuvenile222s Date Of Birthen-USAgeen-USRaceen-USSexen-USG.S. 7B-101, -400, -402en-USen-US þ en-US þ en-USen-USen-US þ þ en-US(Check only the blocks en-USthat apply.) þ þ þ en-USABUSED JUVENILEen-US þ þ þ en-US þ þ þ en-US þ þ þ en-US þ þ þ en-US þ þ þ en-US þ þ þ en-US þ þ þ en-US þ en-USen-US(date or time period)en-US en-US en-USen-US(State facts supporting allegations that en-USthe juvenile is an abused juvenile as indicated above. Attach additional pages if necessary.) en-US en-US en-US en-US en-USen-US en-USen-USen-USen-US American LegalNet, Inc. www.FormsWorkFlow.com þ þ þ en-USNEGLECTED JUVENILEen-US þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-US(date or time period) en-US en-USen-US(State facts supporting allegations that en-USthe juvenile is a neglected juvenile as indicated above. Attach additional pages if necessary.) þ þ þ en-USDEPENDENT JUVENILEen-US þ þ þ en-US þ þ þ en-US þ en-US(date or time period) en-US en-USen-US(State facts supporting allegations that en-USthe juvenile is a neglected juvenile as indicated above. Attach additional pages if necessary.) en-USSIGNATURE OF ATTORNEY en-US(if applicable) en-USen-USprotection, or supervision of the State. en-USen-US en-USVERIFICATION en-USName And Address Of Petitioneren-USDateen-USSignature Of Person Authorized To Administer Oaths en-USSWORN/AFFIRMED AND SUBSCRIBED TO BEFORE MEen-USDate My Commission Expiresen-USCounty Where Notarizeden-USSignature Of Petitioneren-USTelephone No. en-US en-US County Department of Social Services þ en-USNotary þ en-USDirector þ en-USAuthorized Representative Of Directoren-USSEAL þ en-USDeputy CSC þ en-USAssistant CSC þ en-USClerk Of Superior Court þ en-USDistrict Court Judge þ en-USMagistrate en-USDateen-USSignature Of Attorneyen-USName And Address Of Attorney en-USWITNESS(ES) en-USen-USen-US American LegalNet, Inc. www.FormsWorkFlow.com