File No. Name And Address Of JuvenilePETITION -OBSTRUCTION OF OR INTERFERENCEWITH JUVENILE INVESTIGATION(ABUSE/NEGLECT/DEPENDENCY) STATE OF NORTH CAROLINA CountyIn The General Court Of JusticeDistrict Court DivisionIN THE MATTER OF Juvenile222s Date Of BirthName Of PetitionerAgeRaceSexG.S. 7B-303 Name And Address Of Respondent 1Name And Address Of Respondent 2 (date) NameAddressRelationship/TitleTelephone No. AOC-J-120, Rev. 4/18 American LegalNet, Inc. www.FormsWorkFlow.com VERIFICATION Name And Address Of PetitionerDateSignature Of Person Authorized To Administer Oaths SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE MESignature Of PetitionerTelephone No. Director Authorized Representative Of DirectorSEAL Magistrate SIGNATURE OF ATTORNEY (if applicable) Date AOC-J-120, Side Two, Rev. 4/18 American LegalNet, Inc. www.FormsWorkFlow.com