File No. Name And Address Of JuvenileORDER FORNONSECURE CUSTODY(UNDISCIPLINED/DELINQUENT) STATE OF NORTH CAROLINA CountyIn The General Court Of JusticeDistrict Court DivisionIN THE MATTER OF Name And AddressName And AddressJuvenile222s Date Of BirthAgeRaceSexG.S. 7B-1902, -1903, -1904, -1905, -1907 TO ANY LAW ENFORCEMENT OFFICER OR OTHER AUTHORIZED PERSONYOU ARE ORDERED to assume custody of the above-named juvenile for placement in nonsecure custody and to make due return on this Order. You are also ordered to give a copy of this order to the juvenile222s parent, guardian, or custodian named above.The juvenile shall be placed in nonsecure custody with: þ þ 1. þ (designate person) þ . þ þ 2. þ the Department of Social Services of the county named above, for temporary residential placement in a licensed foster home, a home otherwise authorized by law to provide such care, a facility operated by a department of social services, or the following relative222s home, or other home or facility, which the court hereby approves: þ . þ The department of social services is authorized to arrange for and consent to only the following types of evaluation and/or þ þ .petition are true, and that: þ þ 1. þ the juvenile is a runaway and consents to nonsecure custody. þ þ 2. þ the juvenile meets one or more of the criteria in G.S. 7B-1903(b) for secure custody, but it is in the juvenile222s best interest to be þ a. þ the juvenile222s continuation in or return to the juvenile222s own home would be contrary to the juvenile222s best interest. þ b. þ DSS made reasonable efforts to prevent or eliminate the need for placement, as follows (or attached): þ þ þ þ . þ þ c. þ 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. (Describe immediate threat of harm): þ þ þ þ . þ þ d. þ DSS did not make reasonable efforts to prevent or eliminate the need for placement, and efforts were not precluded by an immediate threat of harm to the juvenile.(Over)If the person above gives telephonic approval: Name Of Judge/Judge222s Designee (type or print)Maximum Duration Of Custody þ Judge þ Judge222s Designee DateSignature Of Judge/Judge222s Designee Name And Title Of Person Receiving Telephonic ApprovalSignature Of Person Receiving Telephonic ApprovalTime þ AM PM Custodian Guardian Parent Custodian Guardian ParentNC-JOIN No. American LegalNet, Inc. www.FormsWorkFlow.com Signature And Title Of Person Making ReturnSignature And Title Of Person Making ReturnSignature And Title Of Person Making ReturnName Of Person To Whom Copy GivenName Of Person To Whom Copy GivenName Of Person To Whom Copy GivenRelationship To JuvenileRelationship To JuvenileRelationship To JuvenileDepartment Or AgencyDepartment Or AgencyDepartment Or Agency þ þ 1. þ The juvenile named in this Order was taken into custody at AM PM, on (date) þ , and released to (name and/or location) þ at AM PM, on (date) . þ þ 2. þ Though diligently sought, the juvenile named in this Order could not be found in this county. (Add any comments or information about the juvenile222s possible whereabouts.) RETURN ON ORDER Date Order ReceivedDate Order Returned American LegalNet, Inc. www.FormsWorkFlow.com