Fill and Sign the State Laws on Family Engagement in Education Amazon S3 Form

JD-1721, 02/18 Petition under Chapter 938 – Delinquency, Protection or Services, Civil Law/Ordinances §§938.25 and 938.255, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY For Official Use IN THE INTEREST OF Name Amended Petition under Chapter 938 Delinquency (under age 17) Protection or Services (under age 18) Civil Law/Ordinances ( under age 16) Date of Birth Case No. D.A. Case No. I STATE ON INFORMATI ON AND BELIEF THAT T HE FOLLOWING IS TRUE : [If unknown or c annot be ascertained, so state] 1. Juvenile’s Name Date of Birth Sex Female Male Race Height Weight Hair Color Eye Color Juvenile’s Street and City Address Juvenile has previously been adopted? Yes No Parent 1’s Name and Address See attached for additional parties Legal Status: Birth Adjudicated /Adoptive Presumed Alleged Unknown Parent 1’s Date of Birth Parent 2’s Name and Address See attached for additional parties Legal Status: Birth Adjudicated /Adoptive Presumed Alleged Unknown Parent 2’s Date of Birth Guardian Legal Custodian Foster Par ent Spouse, if any. If none of preceding, nearest relative. [Name] [Address] Juvenile in temporary custody? No Yes: Date Time a.m. p.m. Where held Not disclosed –threat of imminent danger to juvenile/physical custodian. 2. If petit ion alleges jurisdiction under §938.13(4), (6), (6m), or (7), Wis. Stats., answer the following: Juvenile is subject to federal Indian Child Welfare Act? (25 USC §§1901 -1963) No Undetermined (Explain: ) (For an Indian juvenile who is placed out -of-home, use the Indian Child Welfare Act version [IW -1721] of this petition.) Name and Address of School Enrolled 3. Under section(s) , the juvenile is delinquent in need of protection or services, supervision, care or rehabilitation in violation of civil law and/or ordinances because: See attached Petition under Chapter 938 – Delinquency, Protection or Services, Civil Law/Ordinances Page 2 of 2 Case No. JD-1721, 02/18 Petition under Chapter 938 – Delinquency, Protection or Services, Civil Law/Ordinances §§938.25 and 938.255, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 4. Th e juvenile is placed out -of-home. A. Placement in the home at this time is is not contrary to the welfare of the ju venile and the community. B. Reasonable efforts to prevent removal were [Complete one of the following] made by the department or agency responsible for providing services. made by the department or agency responsible for providing services, although an emergency situation resulted in immediate removal of the child from the home. not required under §938.355(2d ), Wis. Stats . 5. The person who took this juvenile into custody and the intake worker have made reasonable efforts to return the juvenile home while assuring the juvenile’s health and safety. I request adjudication and entry of an appropriate dispositional order. Pros ecutor  Petitioner Name of Prosecutor Printed or Typed Name of Petitioner Printed or Typed Date Date