Fill and Sign the Cover Sheet State of Arkansas Circuit Court Juvenile Form

COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DEPENDENCY-NEGLECT & FINS 1 1/1/201 8 This juvenile cover sheet is required by Supreme Court Administrative Order 8. The data contained herein shall not be admissible as evidence in any court proceeding or replace or supplement the filing and service of pleadings, orders, or other papers as required by law or Supreme Court rule. Instructions are located on the following page. County: District: Filing Date: Judge: Division: Case ID: Case Type (choose only one IF a new case or an adoption in a Dependency -Neglect case):  Juvenile 1 Juvenile 2 Last Name Last Name Suffix Suffix First Name First Name Middle name Middle name DL/State ID / Contexte ID DL/State ID / Contexte ID SSN SSN Date of Birth Date of birth Sex Male Female  Sex Male Female  Ethnicity Hispanic Non -Hispanic  Ethnicity Hispanic Non -Hispanic  Race Race Removal date  Removal date  Education Plan IEP 504 N/A  Education Plan IEP 504 N/A  School status School status  School name School name Interpreter needed? Yes: No other language : Interpreter needed? Yes: No other language : Case IDs of other cases involving this/these juvenile(s): COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DEPENDENCY-NEGLECT & FINS 2 1/1/201 8 Petitioner Attor ney of Record : Bar #: For the: Petitioner Juvenile Parent Intervenor Email Address: Parent /Guardian 1 Last Name Phone Suffix Email First Name SSN Middle Name DOB DL/State ID / Contexte ID Interpreter needed? Yes: No other language: Address City, State ZIP Parent of All only this child(ren): Manner of filing: (MFO) Original Re-Open (MFT) Transfer If reopen or petition in existing case, select the type of petition: Petitioner (if school representative or other adult) Relationship to child(ren) Phone Last Name Email Suffix Self -represented Yes No First Name DOB DL/State ID Interpreter needed? Yes: No other language: Address City, State ZIP