IN THE DISTRICT COURT OF ______________________ COUNTY STATE OF OKLAHOMA JUVENILE DIVISION IN THE MATTER OF: DOB: ______________ DOB: ______________ DOB: ______________ DOB: ______________ DOB: ______________ DOB: ______________ ) ) ) JD- _______________________ ) ) Date: ____________________ ) Judge: ___________________ ) Alleged Deprived Child(ren). APPLICATION TO TAKE MINOR CHILD(REN) INTO EMERGENCY CUSTODY COMES NOW the State of Oklahoma, by and through ___________________________, Assistant District Attorney, and pursuant to 10A O.S. � 1-4-201 (A), moves the Court for an Order to take the above-named child(ren) into custody, for the following reasons: The attached sworn Affidavit or sworn testimony of _________________________________ states facts sufficient to demonstrate to the Court that there is reasonable suspicion to believe the following child(ren): all named child(ren)/or these specified child(ren), ______________________, _____________________, ______________________, _____________________, ____________________, _____________________, is/are: in need of immediate protection due to an imminent safety threat, the circumstances of surroundings of the child(ren) are such that continuation in the child(ren)'s home or in the care or custody of the parent, legal guardian, or custodian would present an imminent safety threat to the child(ren), or the child(ren), including a child(ren) with a disability, is/are unable to communicate effectively about abuse, neglect or other safety threat or is in a vulnerable position due to the inability to communicate effectively and the child(ren) is/are in need of immediate protection due to an imminent safety threat. an emergency exists, preventing reasonable and/or active efforts to allow the child(ren) to remain in the home, or reasonable and/or active efforts have been made to prevent the need to remove the child(ren) from the home, and have failed, to wit: _____________________________________________ _______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Application to take Minor Child(ren) into Emergency Custody OK-J-UO-0001A Version 1.1.16.2 Page 1 of 2 OCIS Docket Code: APLI American LegalNet, Inc. www.FormsWorkFlow.com WHEREFORE, Movant requests the Court enter an Order to take the minor child(ren) into emergency custody for the reasons set forth. DATED this ___________ day of __________________________, 20__________. By: ____________________________________ Assistant District Attorney Application to take Minor Child(ren) into Emergency Custody OK-J-UO-0001A Version 1.1.16.2 Page 2 of 2 OCIS Docket Code: APLI American LegalNet, Inc. www.FormsWorkFlow.com