Dependency Complaint {JUV-2}

COMPLAINT IN THE JUVENILE COURT OF __________________________ COUNTY, GEORGIA Case Number _______________________________________________________________________________ Name: (Last, F.M.) Age: AKA: DOB: / /_______________________________________________________________________________ Race: Lives Res.: __________________________Sex: With: Bus.: _______________________________________________________________________________ (Name) (Phone) Childs Address: _______________________________________________________________________________ (Street) (Apt. #) (City) (County) (State) (Zip)Mothers Res.: __________________________Name: Phone: Bus.: _______________________________________________________________________________ (Include Mothers Maiden Name In Parentheses) Mothers Address: _______________________________________________________________________________ (Street) (Apt. #) (City) (County) (State) (Zip)Fathers Res.: __________________________Name: Phone: Bus.: _______________________________________________________________________________ Fathers Address: _______________________________________________________________________________ (Street) (Apt. #) (City) (County) (State) (Zip)Legal Res.: __________________________Custodian: Phone: Bus.: _______________________________________________________________________________ Custodians Address: _______________________________________________________________________________ (Street) (Apt. #) (City) (County) (State) (Zip)Complaint: / / _______________________________________________________________________________ (Code Section) (Misd./Fel.) Date of OffenseComplaint: / / _______________________________________________________________________________ (Code Section) (Misd./Fel.) Date of OffenseComplaint: / / _______________________________________________________________________________ (Code Section) (Misd./Fel.) Date of OffenseRev. 01/2001 JUV-2<<<<<<<<<********>>>>>>>>>>>>> 2 _________________ Case NumberTaken Into Custody: Yes ( ) No ( ) By Whom: _______________________________________________________________________________ (Name) (Agency) Placement of Date: / /Deprived Child: Time: _______________________________________________________________________________ Person notified: Date: / /By: VIA: Time: ______________________________________________________________________________ Place Date: / /Detained: Yes ( ) No ( )Detained: Time: Authorized by: _______________________________________________________________________________ Released To: Date: / /Relation: Time: _______________________________________________________________________________ Co-perpetrator: _______________________________________________________________________________ (Name and Age) Co-perpetrator: _______________________________________________________________________________ (Name and Age) Victims Name: Phone #: Victims Address: _______________________________________________________________________________ Victims Name: Phone #: Victims Address: _______________________________________________________________________________ Give Complete Details of Offense(s) or Complaint(s) and Apprehension: _______________________________________________________________________________ Investigating Agency: Officer: P.D. Report #: Phone #: _______________________________________________________________________________ Complainants Complainants Name:______________________________Address: Signature: Date: Phone: _______________________________________________________________________________ Rev. 01/2001 JUV-2