Fill and Sign the State V Knolly Brown Hearing Transcript the North Carolina Form

SIGNATURE OF ATTORNEY (if applicable) Date Signature Of Attorney Name And Address Of Attorney File No. Name Of Juvenile Determined By Agency To Be Abused Or Seriously Neglected Name And Address Of Individual Seeking Judicial Review Date Of Birth Of Individual Seeking Judicial Review PETITION FOR JUDICIAL REVIEW RESPONSIBLE INDIVIDUALS LIST ABUSE SERIOUS NEGLECT STATE OF NORTH CAROLINA County In The General Court Of Justice District Court Division IN THE MATTER OF G.S. 7B-323 Pursuant to G.S. 7B-200(a)(9), I seek to invoke the jurisdiction of this Court. Pursuant to G.S. 7B-323, I �le this petition for judicial review of the determination by the Director of the County Department of SocialServices of abuse or serious neglect and my identi�cation as a responsible individual. 1. Pursuant to G.S. 7B-320, On (date) ____________________ I received personal written notice of the results of the investigative assessment and the Director’s determination that I abused or seriously neglected the juvenile named above and that my name will be added to the Responsible Individuals List. OR 2. Pursuant to G.S. 7B-323(e), I became aware that my name was included on the Responsible Individuals List on (date) ____________________, by and request a judicial review in the interest of justice or for extraordinary circumstances as follows: . 3. Pursuant to G.S. 7B-324, I af�rm I have not been criminally convicted as a result of this incident. �led this petition for judicial review with this Court within 15 days after receiving the Director’s notice. Optional I request that the Court close the hearing to all people except of�cers of the Court, the parties and their witnesses. I request the Court to hear the case to determine whether the Director can prove by a preponderance of the evidence that I abused or seriously neglected the juvenile and whether my name should be on the Responsible Individuals List. Original - File Copy - Director of County DSS Copy - Petitioner Date Name Of Petitioner (type or print) Signature Of Petitioner NOTE TO CLERK: Upon the �ling of a petition for judicial review, the clerk shall calendar the matter for hearing within 45 days from the date the petition is �led at a session of district court hearing juvenile matters or, if there is no such session, at the next session of juvenile court. The clerk shall send notice of the hearing to the petitioner and to the director who determined the abuse or serious neglect and identi�ed the individual as a responsible individual. AOC-J-131, Rev. 4/18 © 2018 Administrative Of�ce of the Courts