Affidavit (Juvenile Probation Violation) {SCCA-491}

STATE OF SOUTH CAROLINA COUNTY OF _______________________ A JUVENILE A Child under Seventeen (17) Years of Age ) IN THE FAMILY COURT ) ____ JUDICIAL CIRCUIT ) ) ) ) AFFIDAVIT ) ) ) ) ) Docket No. ____________________________ PERSONALLY appeared before me, ___________________________________, who first being duly sworn, deposes and says that _________________________________ violated the terms of ( his/ her) probation (as ordered by the Family Court of ___________________________ / / ) in the following particulars, and based on the following County, S. C. on ( facts:_____________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________. Sworn to and Subscribed before me day of , Notary Public for South Carolina My Commission expires ) ) ) ) ) ) ) Signature of Affiant SCCA 491 (12/2009) American LegalNet, Inc. www.FormsWorkFlow.com