Fill and Sign the Undisciplineddelinquent Form

File No. Name And Address Of Juvenile Juvenile’s Date Of Birth Juvenile’s Attorney Age Name Of Movant Name And Address Name And Address Parent Guardian Custodian Parent Guardian Custodian G.S. 7B-2505, -2510, -2515, -2516, -2600 STATE OF NORTH CAROLINA County In The General Court Of Justice District Court Division IN THE MATTER OF (Over) MOTION FOR REVIEW (UNDISCIPLINED/DELINQUENT) PROTECTIVE SUPERVISION PROBATION VIOLATION EXTENDED COMMITMENT VIOLATION OF POST-RELEASE SUPERVISION EXTENSION OF PROBATION OTHER I request the Court to hear and further consider the case of the juvenil\ e named above, as to whom the Court is exercising continuing jurisdiction, and to (specify other requests) . Protective supervision/probation/commitment/post-release supervision is \ scheduled to end on . Being first duly sworn, I say that I have read the foregoing motion and \ know the content thereof and that the same is true of my ownknowledge, except as to those matters alleged upon information and belie\ f, and as to these matters, I believe the same to be true. (Use reverse side for additional Facts and Circumstances.) FACTS AND CIRCUMSTANCES INDICATING NEED FOR REVIEW Title (if applicable) Date My Commission Expires Agency (if applicable) County Where Notarized Date Signature Of Movant Name And Address Of Movant Signature Of Person Authorized To Administer Oaths Notary Deputy CSC Assistant CSC Clerk Of Superior Court SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME SEAL NC-JOIN No. $2&-5HY