IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of: ) ) ) ) ) ) )
A minor under 18 years of age Date of birth:
REQUEST TO ORDER RESTITUTION The Division of Juvenile Justice at the Department of Health and Social Services requests that restitution be ordered related to the above-noted proceeding for the following reasons:
This request is supported by the attached Affidavit and Memorandum. The minor opposes this request. The minor does not oppose this request.
(date) Approved by
I certify that on a copy of this document was sent to: DA Minor's Attorney Parent or Guardian Other: By:
DL-166 (5/09)(cs) REQUEST TO ORDER RESTITUTION