IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of: ) ) ) ) ) ) ) )
A minor under 18 years of age Date of birth:
CASE NO. REQUEST TO MODIFY OR AMEND DISPOSITION ORDER
The Division of Juvenile Justice at the Department of Health and Social Services requests that the disposition order dated regarding the above-named minor be amended or modified as follows:
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 given or sent to: DA Minor's Attorney Parent or Guardian Other: By:
DL-167(5/09)(cs) REQUEST TO MODIFY OR AMEND DISPOSITION ORDER