400 - 00 110 Juvenile Petition (0 7 /2018) Page 1 of 1 STATE OF VERMONT SUPERIOR COURT FAMILY DIVISION Unit Docket No. In RE ( J uvenile) : Juvenile Information: Physical Address: Mailing Address (if different) : Age: Date of Birth: Female Male Latin/Hispanic: Yes No Unknown Race: African American Asian Caucasian Native American Not Known Not Reported Other Name of Offense (if delinquency) : Incident Date: Count: of V.S.A. Title & Section Date Cited to Court Diversion: Recommended Parent/Guardian/Custodian Information Name: Physical Address: Mailing Address (if different) : Day/Evening Phone: / Email: Safe at Home Parent/Guardian/Custodian Information Name: Physical Address: Mailing Address (if different) : Day/Evening Phone: / Email: Safe at Home JUVENILE PETITION Under the Vermont Juvenile Judicial Proceedings Act, the Petitioner respectfully represents that: 1. Petitioner is the State's Attorney/Deputy State's Attorney for this County, 2. To the best of petitioner's information and belief the information as set forth above is correct ; 3. The child is or may be d elinquent y outhful o ffender in need of care or supervision, in that the child is: abandoned or abused without proper care beyond control of parent, guardian or custodian truant b ased upon the following allegations set forth in the attached affidavit: 4. The child is now in the legal custody of UCCJEA affidavit of child custody is attached. (33 V.S.A 247 5310(b)(3))5. It is in the best interests of the child and the public for that proceedings under the Vermont Juvenile Judicial Proceedings Act bebrought. THEREFORE, the Petitioner asks this Court to hear the Petition and to find in favor of the petition and to make such other or ders as may be appropriate. Dated Signature Signed and sworn to before me: Probable Cause Found Dated Signature of Superior Court Judge Date Signature of Notary Public Expiration Date American LegalNet, Inc. www.FormsWorkFlow.com