Fill and Sign the Juvenile Ejj Dys Releasereview Hearing Disposition Sheet Form

COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DELINQUENCY/EJJ 1 2/9/2017 This delinquency/EJJ cover sheet is required by Supreme Court Administrative Order 8 to be completed and filed for every juvenile. 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 at www.courts.arkansas.gov . County: District: Filing Date: Judge: Division: Case ID: Cas e Type (select one) : (JD) Delinquency (EJ) Extended Juvenile Jurisdiction Is this an amendment?  Yes  No If yes, reason: Does this juvenile ha ve other active cases ?  Yes  No Case ID s: Juvenile information Last Name Alias Suffix Address First Name Middle Name City Contexte ID State DLN/State ID ZIP SSN Custody date Date of Birth Arrest date Sex Male Female  ATN  Ethnicity Hispanic Non -Hispanic  Was this a school -related arrest? Yes No  Race Check one  School Status Check one  Educational Accommodation IEP 504 N/A Interpreter needed? Yes No Language: Other:  Parent /Guardian 1 Parent /Guardian 2 Relationship Relationship Last Name Last Name Suffix Suffix First Name First Name Middle Name Middle Name DL N/State ID DL N/State ID SSN SSN Date of Birth Date of birth Address Address City, State ZIP City, State ZIP Email Email Interpreter needed? Interpreter needed? Yes: No Yes: Noother language: other language: ___________________________ COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DELINQUENCY/EJJ 2 2/9/2017 Code # Offense name/Description A/S/C Offense Date Counts F/M Class Othe r Juveniles/Defendants: Related Case IDs: Att orney Providing Information: Bar #: Email Address: Phone: Manner of filing (choose one) : D ate of transfer hearing : Was juvenile’s attorney present? Yes No  If a detention hearing related to this petition has already occurred, Date of detention hearing (HD60) : Detention hearing outcome: Continue detention Release on personal recognizance Release to parent/guardian/custodian Release to qualified person/agency Reasonable restrictions Release upo n order to appear Release upon bond Was juvenile’s attorney present? Yes No The offenses in the attached information include: