Free COMPLAINT, YOUTH IN CRISIS - Connecticut

JD-JM-142 Rev. 9-02 C.G.S. § 46b-120, 46b-121, 46b-150f Public Act 02-109, Sec. 1

COMPLAINT YOUTH IN CRISIS

STATE OF CONNECTICUT

SUPERIOR COURT
JUVENILE MATTERS www.jud.ct.gov

TO: The Superior Court, Juvenile Matters
ADDRESS OF COURT NAME OF YOUTH NAME OF MOTHER NAME OF FATHER NAME OF GUARDIAN, IF ANY INDIAN TRIBE/RESERVATION, IF ANY

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DOCKET NO. ADDRESS OF YOUTH ADDRESS OF MOTHER ADDRESS OF FATHER ADDRESS OF GUARDIAN SCHOOL/GRADE SEX DATE OF BIRTH

COMPLAINT The undersigned believes that the above youth is a youth in crisis because said youth is sixteen or seventeen years of age, and, within the last two years: ("X" appropriate box(es)) has without just cause run away from the parental home or other properly authorized and lawful place of abode; is beyond the control of parents, guardian or other custodian; OR has four unexcused absences from school in any one month or ten unexcused absences in any school year. For each box checked above, describe in detail the acts or omissions of said youth upon which the complaint is made. (Be specific and include dates.)

COMPLAINANT'S SIGNATURE

AGENCY AND TITLE (If applicable)

DATE SIGNED

NOTICE: The youth may not be placed in detention based on this complaint.
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