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Approved, SCAO

JIS CODE: PET

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY
Court address ORI MICTN

PETITION (DELINQUENCY PROCEEDINGS) Supplemental

CASE NO. PETITION NO.

Court telephone no. TCN SID DLN

1. In the matter of name(s), alias(es), DOB

2. The above named juvenile Citations and allegations:

comes within the provisions of MCL 712A.2.
operator/chauffeur driver's license

has violated probation as follows:
no license vehicle type

commercial driver's license

See attached sheet for further allegations.

Member of or eligible for membership in American Indian tribe or band, stated above.

3. An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor has been previously filed in Court, Case Number , was assigned to Judge , and remains is no longer pending. 4. I designate this case as a case in which the juvenile is to be tried in the same manner as an adult. 5. The above named juvenile is a legal resident(s) of County, and resides in the care and custody of . 6. The names and addresses of the parents, guardian, legal custodian, or nearest known relative are as follows:
NAME Father Mother Guardian/Legal custodian/Nearest known relative Putative ADDRESS HOME PHONE WORK PHONE

7. I request the court to (check either box a or b) a. review the information and make an appropriate decision. b. authorize this petition and take jurisdiction over the juvenile. Further, I request the court to 1) issue an order to apprehend and/or detain the juvenile. 2) find the juvenile in contempt of court for violating a minor personal protection order. 3) find the juvenile has violated probation and notify the juvenile to appear for the hearing. order the juvenile apprehended and brought to court for a detention hearing. 4) designate this case as a case in which the juvenile is to be tried in the same manner as an adult. I declare that the statements in this petition are true to the best of my information, knowledge, and belief.

Petitioner's signature Print or type name

Date

Agency/Address City, state, and zip Telephone no.

Petition approved for submission:
Prosecutor's signature Date

8. A preliminary inquiry and/or hearing has been conducted and the filing of this petition

is

is not

authorized.

Date

Judge/Referee

Bar no.

JC 04a (9/07)

PETITION (DELINQUENCY PROCEEDINGS)

MCL 600.2950h-600.2950m, MCL 712A.2, MCL 712A.2d, MCL 764.15b, MCR 3.903(A)(19), MCR 3.926(A), MCR 3.931, MCR 3.944, MCR 3.951