File No. STATE OF NORTH CAROLINA In The General Court Of Justice District Court Division County IN THE MATTER OF: JUVENILE PETITION CONCEALMENT OF MERCHANDISE (SHOPLIFTING) (DELINQUENT) Name And Address Of Juvenile Juvenile's Date Of Birth Age Race Sex G.S. 7B-1501(7), -1801, -1802 Name Of Petitioner Category Of Offense Misdemeanor, Class Offense Code Offense In Violation Of G.S. Physical Address Of Offense, If Applicable Date Of Offense Time Of Offense 14-72.1 AM PM 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 is under the age of eighteen (18) and committed a delinquent act in this district while under the age of sixteen (16). 2. The names, addresses and telephone numbers of the juvenile's parents, guardian, or custodian are as follows: NAME RELATIONSHIP/TITLE ADDRESS TELEPHONE NO. 3. CONCEALMENT OF MERCHANDISE (SHOPLIFTING) [G.S.14-72.1] The juvenile is a delinquent juvenile as defined by G.S. 7B-1501(7) in that on or about the date of offense shown and in the county named above the juvenile did unlawfully, willfully, and without authority conceal: (describe items) the goods and merchandise of a store (name store) while still upon the premises of the store and not having theretofore purchased the goods and merchandise. AOC-J-315, Rev. 10/08 © 2008 Administrative Office of the Courts , (Over) American LegalNet, Inc. www.FormsWorkflow.com I request the court to hear the case to determine whether the allegations are true and whether the juvenile is within the jurisdiction of the Court as a delinquent juvenile. VERIFICATION Being first duly sworn, I say that I have read the allegations in the petition and that the same are true to my own knowledge, except as to those matters alleged upon information and belief, and as to those, I believe them to be true. Signature Of Petitioner SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Date Address Signature Of Person Authorized To Administer Oaths Deputy CSC Assistant CSC City, State, Zip Clerk Of Superior Court Magistrate Date My Commission Expires Agency (if applicable) County Where Notarized Title (if applicable) Notary Telephone No. SEAL Witness(es) Name Address Telephone No. Date Complaint Received By Department Of Juvenile Justice And Delinquency Prevention 15-DAY EXTENSION OF TIME TO FILE PETITION Pursuant to G.S. 7B-1703, at the discretion of the undersigned chief court counselor, the time to file a petition in the above captioned case is extended 15 days. Date Name Of Chief Court Counselor Signature Of Chief Court Counselor Decision of Court Counselor Regarding the Filing of the Petition Date 1. Approved for Filing 2. Not Approved for Filing a. Closed b. Diverted and Retained Time AM PM Name Of Court Counselor Giving Telephonic Approval Name And Title Of Person Receiving Telephonic Approval Date Signature Of Court Counselor Signature Of Person Receiving Telephonic Approval Post-Diversion Approval For Filing Of Petition Date Signature Of Court Counselor Approved for Filing AOC-J-315, Side Two, Rev. 10/08 © 2008 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkflow.com