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 JUVENILE PETITION CONCEALMENT OF MERCHANDISE (SHOPLIFTING) (DELINQUENT) Social Security No. Of Juvenile G.S. 7B-1501(7), -1801, -1802 Juveniles Date Of Birth Age Race Sex Category Of Offense Misdemeanor, Class Name Of Petitioner Date Of Offense Time Of Offense 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 juveniles 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, New 7/99 (Replaces J-109) 1999 Administrative Office of the Courts (Over) >>>> 2 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 AND SUBSCRIBED TO BEFORE ME Date Address Signature Of Person Authorized To Administer Oaths City, State, Zip Deputy CSC Assistant CSC Clerk Of Superior Court Agency (if applicable) Magistrate Date My Commission Expires Title (if applicable) Telephone No. SEAL Notary Witness(es) Name Address Telephone No. Decision of Intake Counselor Regarding the Filing of the Petition Date Time 1. Approved for Filing AM PM 2. Not Approved for Filing Name Of Intake Counselor Giving Telephonic Approval a. Closed b. Diverted and Retained Name And Title Of Person Receiving Telephonic Approval Date Signature Of Intake Counselor Signature Of Person Receiving Telephonic Approval Post-Diversion Approval For Filing Of Petition Date Signature Of Intake Counselor Approved for Filing AOC-J-315, Side Two, New 7/99 (Replaces J-109) 1999 Administrative Office of the Courts