Commonwealth of Pennsylvania In the Interest Of: IN THE COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA JUVENILE DIVISION ________________ Date of Birth _________ DOCKET NO: CP- -JV- - EXHIBIT A Offenses Alleged on the Juvenile Petition # 1 Offense Statute Grade Admission Admitted Denied Finding Substantiated Not Substantiated __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated 2 __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated 3 __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated 4 __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated 5 __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated 6 __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated 7 __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated 8 __________ Lesser Offense(#___) __________________ Page 1 of ___ American LegalNet, Inc. www.FormsWorkFlow.com  Offenses Alleged on the Juvenile Petition, continued # Offense Statute Grade Admission Admitted Denied Finding Substantiated Not Substantiated __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated __________ Admitted Denied Lesser Offense(#___) __________________ Substantiated Not Substantiated __________ Lesser Offense(#___) __________________ Page ___ of ___ American LegalNet, Inc. www.FormsWorkFlow.com