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Fill and Sign the Complaintreferral in the Juvenile Court of Paulding Form

Fill and Sign the Complaintreferral in the Juvenile Court of Paulding Form

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Rev. 01/2001JUV-2 COMPLAINT IN THE JUVENILE COURT OF __________________________ COUNTY, GEORGIA _______________________________________________________________________________ Name: (Last, F.M.) Age: AKA: DOB: / / _______________________________________________________________________________ Race: Lives Res.: __________________________ Sex: With: Bus.: _______________________________________________________________________________ (Name)(Phone) Child's Address: _______________________________________________________________________________ (Street)(Apt. #)(City) (County)(State) (Zip) Mother's Res.: __________________________ Name: Phone: Bus.: _______________________________________________________________________________ (Include Mother's Maiden Name In Parentheses) Mother's Address: _______________________________________________________________________________ (Street)(Apt. #)(City) (County)(State) (Zip) Father's Res.: __________________________ Name: Phone: Bus.: _______________________________________________________________________________ Father's Address: _______________________________________________________________________________ (Street)(Apt. #)(City) (County) (State) (Zip) Legal Res.: __________________________ Custodian: Phone: Bus.: _______________________________________________________________________________ Custodian's Address: _______________________________________________________________________________ (Street)(Apt. #)(City) (County)(State) (Zip) Complaint: / / _______________________________________________________________________________ (Code Section)(Misd./Fel.)Date of Offense Complaint: / / _______________________________________________________________________________ (Code Section)(Misd./Fel.)Date of Offense Complaint: / / _______________________________________________________________________________ (Code Section)(Misd./Fel.)Date of Offense Case Number Rev. 01/2001JUV-2 Taken 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) Victim's Name: Phone #: Victim's Address: _______________________________________________________________________________ Victim's Name: Phone #: Victim's Address:_______________________________________________________________________________ Give Complete Details of Offense(s) or Complaint(s) and Appr ehension: _______________________________________________________________________________ Investigating Agency: Officer: P.D. Report #: Phone #: _______________________________________________________________________________ Complainant's Complainant's Name:______________________________ Address: Signature: Date: Phone: _______________________________________________________________________________ _________________ Case Number

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