Fill and Sign the Based on Violation Form

File No. Name And Address Of Juvenile Juvenile’s Date Of Birth Date Of Hearing Age G.S. 7B-2513, -2516 STATE OF NORTH CAROLINA County In The General Court Of Justice District Court Division IN THE MATTER OF The following persons were present at the hearing: JUVENILE LEVEL 3 DISPOSITION AND COMMITMENT ORDER (BASED ON VIOLATION OF POST-RELEASE SUPERVISION ) The case came on for disposition upon a finding that the juvenile, who was previously given a Level 3 disposition, violated the terms of Post-Release Supervision dated (date of Post-Release Supervision) . Based on the evidence presented, the Court makes the following Findings \ of Fact: 1. The offense for which the juvenile was given a Level 3 disposition and that is the basis for this commitment is: 2. The Court received and considered predisposition report risk assessment needs assessment and incorporates the contents of the predisposition report risk assessment needs assessment by reference. (If the report is incorporated, a copy of the report MUST be attached to the order.) 3. Other Findings: (Continue on attached pages if necessary. State any findings regarding the specific reasons for the violation; the need to hold the juvenile accountable; the importance of protecting the public; the degree of the juvenile’s culpability; the juvenile’s rehabilitative and treatment needs; and available and appropriate resources.) Adjudication Date Class F/M Offense (with statute number) (Over) FINDINGS NC-JOIN No. Name Name Relationship/Title Relationship/Title AOC-J-467, Rev. 12/17