Free jc01.p65 - Michigan

Approved, SCAO

JIS CODE: CMP

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY
Court address Last

COMPLAINT (REQUEST FOR ACTION, DELINQUENCY PROCEEDINGS), PAGE 1

CASE NO. PETITION NO.

Court telephone no. First Middle

1. In the matter of
2. Date of birth 6. Height 3. Sex 7. Weight 4. Race 8. Eye color 5. Member of or eligible for membership in American Indian Tribe or Band 9. Hair color 10. School/District 11. Municipality and county of legal residence

BASIS FOR REQUEST

12. Brief statement of the allegations and basis for any request for court-ordered apprehension, including the citations and date, time, and location of offense Operator/Chauffeur driver license Commercial driver license No license Vehicle type

13. Codefendant(s): name(s), alias(es), DOB

SOCIAL INFORMATION
14. Father's name 15. Mother's name 16. Stepparent's name 17. Guardian/Legal custodian's name 18. Divorced? Date of divorce Address Address Address Address Place of divorce: (county, state) Home phone Home phone Home phone Home phone Work phone Work phone Work phone Work phone

No
19. Custody to:

Yes Mother Mother

Father Father

Other (name and address): Stepfather Stepmother Other:

20. Juvenile living with:

REQUEST 21. I REQUEST a. a petition be authorized. b. the court review the information and make an appropriate disposition. c. an order be issued to apprehend the juvenile pending the preliminary hearing pursuant to MCR 3.933(B). permission to enter the premises at . d. an order be issued to detain the juvenile pending the preliminary hearing pursuant to MCR 3.934(B). I declare that this complaint has been examined by me and that its contents are true to the best of my information, knowledge, and belief.
Complainant's signature Print or type name Address/Agency Date Telephone no.

MCL 712A.2, MCL 712A.11, MCL 712A.14, MCL 712A.15, MCR 3.903(A)(9), MCR 3.933(A), MCR 3.934, MCR 3.983 JC 01 (9/06)

COMPLAINT (REQUEST FOR ACTION, DELINQUENCY PROCEEDINGS), PAGE 1

Approved, SCAO

JIS CODE: CMP

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY
Court address Last

COMPLAINT (REQUEST FOR ACTION, DELINQUENCY PROCEEDINGS), PAGE 2

CASE NO. PETITION NO.

Court telephone no. First Middle

1. In the matter of CUSTODY Fill out completely
22. Basis for apprehension by police without court order 23. Check if applicable

The officer had reason to believe that because of the nature of the offense, the interest of the juvenile or the interest of the public would not be protected by release of the juvenile. Parent/guardian/legal custodian could not be located or refused to take custody of the juvenile.
24.Release and recognizance

Miranda warning given Offense admitted Offense denied Parents/Guardian/Legal custodian present

Attorney present Fingerprints taken Photograph taken Line-up held

I acknowledge that the juvenile has been released to my custody, and I promise to bring the juvenile to the court upon notice.

Date

Signature

Relationship to juvenile

NOTIFICATION TO PARENT, GUARDIAN, OR LEGAL CUSTODIAN 25. I notified or attempted to notify the person(s) listed below about the date, time, and place of the preliminary hearing. The method of contact or attempted contact is described below and includes the date and time of notification for each.
26. Name 27. Name 28. Name 29. Name notified attempted notified attempted notified attempted notified attempted Methods used Methods used Methods used Methods used Date Date Date Date Time Time Time Time

ADDITIONAL COMMENTS

MCL 712A.2, MCL 712A.11, MCL 712A.14, MCR 3.903(A)(9), MCR 3.933(A), MCR 3.934, MCR 3.983 JC 01 (9/06)

COMPLAINT (REQUEST FOR ACTION - DELINQUENCY PROCEEDINGS), PAGE 2