Fill and Sign the Salisbury Post Issuu Form

File No. Name And Address Of Juvenile PETITION - OBSTRUCTION OF OR INTERFERENCE WITH JUVENILE INVESTIGATION (ABUSE/NEGLECT/DEPENDENCY) STATE OF NORTH CAROLINA County In The General Court Of Justice District Court Division IN THE MATTER OF: Juvenile’s Date Of Birth Name Of Petitioner Age Race Sex G.S. 7B-303 Name And Address Of Respondent 1 Name And Address Of Respondent 2 I have sufficient knowledge or information to believe that a case has arisen that invokes the juvenile jurisdiction of the court, and therefore allege that: 1. On or about (date) , the Department of Social Services (DSS) of the county named above received a report of abuse, neglect or dependency concerning the juvenile named above, which requires an investigation as set forth in G.S. 7B-303. 2. The names, addresses, and telephone numbers of the juvenile’s parents, guardian, custodian, or caretaker are as follows: 3. Respondent(s), without lawful cause, has obstructed and/or interfered with the investigation. The obstruction and/or interference consists of the following: a. refusal to disclose the whereabouts of the juvenile. b. refusal to allow personal access to the juvenile. c. refusal to allow observation and/or interview of the juvenile in private. d. refusal to allow access to confidential information and/or records after proper request by DSS pursuant to G.S. 7B-303. e. refusal to allow DSS to arrange for an evaluation of the juvenile by a physician or other expert. f. other conduct which makes it impossible for DSS to carry out its duty to investigate: (specifically describe respondent’s conduct) 4. There is reason to believe that the juvenile is in need of immediate protection and/or assistance. The basis for that belief is as follows: NAME RELATIONSHIP OR TITLE ADDRESSTELEPHONE NO. (See reverse side for additional allegations) AOC-J-120, Rev. 10/16