Fill and Sign the Or Infraction Form

File No. Name And Address Of Juvenile Name Of Petitioner Offense Code Offense In Violation Of G.S. Physical Address Of Offense, If Applicable Date Of Offense Time Of Offense Juvenile’s Date Of Birth Category Of Offense Age Race Sex JUVENILE PETITION (DELINQUENT) G.S. 7B-1501(7), -1801, -1802 I have suf�cient knowledge or information to believe that a case has arisen that invokes the juvenile jurisdiction of the court, and therefore allege that: 1. The juvenile named above is under the age of eighteen (18) and committed a delinquent act in this district while under the age of sixteen (16). ( NOTE: If the respondent is eighteen or older and is alleged to have committed a felony while age thirteen, fourteen, or �fteen, this allegation should be modi�ed accordingly. See G.S. 7B-1601. ) 2. The names, addresses, and telephone numbers of the juvenile’s parents, guardian, or custodian are as follows: 3. The juvenile is a delinquent juvenile as de�ned by G.S. 7B-1501(7) in that on or about the date of the offense shown above and in the county named above, the juvenile did unlawfully, willfully and feloniously (State facts supporting every element of alleged offense.) STATE OF NORTH CAROLINA County In The General Court Of Justice District Court Division IN THE MATTER OF (See reverse side for ADDITIONAL FACTS AND CIRCUMSTANCES) Felony, Class Misdemeanor, Class , Or Infraction AM PM NC-JOIN No. Name Address Relationship/Title Telephone No. AOC-J-310, Rev. 12/17 © 2017 Administrative Of�ce of the Courts ADDITIONAL FACTS AND CIRCUMSTANCES I request the Court to hear the case to determine whether the allegations are true and whether the juvenile is within the jurisdiction of the Court as a delinquent juvenile. Date Complaint Received By Juvenile Justice Section Of The Division Of Adult Correction And Juvenile Justice Pursuant to G.S. 7B-1703, at the discretion of the undersigned chief court counselor, the time to �le a petition in the above captioned case is extended 15 days. Date Name Of Chief Court Counselor Signature Of Chief Court Counselor 15-DAY EXTENSION OF TIME TO FILE PETITION Signature Of Court Counselor Date Date Time Name Of Court Counselor Giving Telephonic Approval Name And Title Of Person Receiving Telephonic Approval Signature Of Person Receiving Telephonic Approval 1. Approved for Filing 2. Not Approved for Filing a. Closed b. Diverted and Retained AM PM Post-Diversion Approval For Filing Of Petition Signature Of Court Counselor Date Approved for Filing DECISION OF COURT COUNSELOR REGARDING THE FILING OF THE PETITION WITNESS(ES) Name Address Telephone No. VERIFICATION Being �rst duly sworn, I say that I have read the allegations in the petition and that the same are true to my own knowledge, except as to those matters alleged upon information and belief, and as to those, I believe them to be true. Date My Commission Expires County Where NotarizedSignature Of Petitioner Date City, State, Zip Address Agency (if applicable) Title Or Relationship To Juvenile Telephone No. Signature Of Person Authorized To Administer Oaths Notary SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME SEAL Deputy CSC Assistant CSC Clerk Of Superior Court Magistrate AOC-J-310, Side Two, Rev. 12/17 © 2017 Administrative Of�ce of the Courts