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State of Michigan County Complaint (Request For Action, Delinquency Proceedings) Case No. Petition No. Judge

This document is a complaint form requesting action and the initiation of delinquency proceedings in a juvenile court case. It provides identifying information about the juvenile such as name, date of birth, physical description, and residence. It also lists any codefendants and provides a brief statement of the allegations and basis for the request. Social information is included about the juvenile's parents and living situation. The complainant is requesting a petition be authorized, an order for apprehension or detention of the juvenile, and notes whether the juvenile's parents were notified.

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52 views2 pages

State of Michigan County Complaint (Request For Action, Delinquency Proceedings) Case No. Petition No. Judge

This document is a complaint form requesting action and the initiation of delinquency proceedings in a juvenile court case. It provides identifying information about the juvenile such as name, date of birth, physical description, and residence. It also lists any codefendants and provides a brief statement of the allegations and basis for the request. Social information is included about the juvenile's parents and living situation. The complainant is requesting a petition be authorized, an order for apprehension or detention of the juvenile, and notes whether the juvenile's parents were notified.

Uploaded by

DJST
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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JIS Code: CMP

STATE OF MICHIGAN CASE NO.


JUDICIAL CIRCUIT - FAMILY DIVISION COMPLAINT
COUNTY (REQUEST FOR ACTION, PETITION NO.
DELINQUENCY PROCEEDINGS)
JUDGE
Court address Court telephone no.

In the matter of
First and last name(s), alias(es)

1. Date of birth 2. Sex 3. Race 4. Member of or eligible for membership in Indian Tribe
Put DOB on Ref. No.
row 10 on MC 97a

5. Height 6. Weight 7. Eye color 8. Hair color 9. School/District 10. Municipality and county of legal residence

BASIS FOR REQUEST 11. Brief statement of the allegations and basis for any request for court-ordered apprehension, including the citations and
date, time, and location of offense  Operator/Chauffeur driver’s license  Commercial driver’s license  No license  Vehicle type

12. Codefendant(s):
Name(s): Alias(es): DOB:
  Put DOB on Ref. No.
  row 11 on MC 97a
  Put DOB on Ref. No.
  row 12 on MC 97a
  Put DOB on Ref. No.
  row 13 on MC 97a
  Put DOB on Ref. No.
  row 14 on MC 97a

SOCIAL INFORMATION
13. Parent’s name Address Home phone Work phone

14. Parent’s name Address Home phone Work phone

15. Stepparent’s name Address Home phone Work phone

16. Guardian/Legal custodian’s name Address Home phone Work phone

17. Divorced? Date of divorce Place of divorce:


No  Yes (county, state)
18. Custody to: (Specify name and include address if not previously listed.)
 
19. Juvenile living with: (Specify name and relationship.)

Approved, SCAO
Form JC 01, Rev. 5/21
MCL 712A.2, MCL 712A.11, MCL 712A.14, MCL 712A.15, MCR 3.903(A)(9),
MCR 3.933(A), MCR 3.934, MCR 3.983
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Complaint (Request for Action, Delinquency Proceedings)  (5/21)  Case No.
Page 2 of 2

REQUEST
20. I REQUEST
a. a petition be authorized.
b. the court review the information and make an appropriate disposition.
c. an order be issued to apprehend the juvenile pending the preliminary hearing pursuant to MCR 3.933(B).
permission to enter the premises at .
d. an order be issued to detain the juvenile pending the preliminary hearing pursuant to MCR 3.934(B).
I declare under the penalties of perjury that this complaint has been examined by me and that its contents are true to the
best of my information, knowledge, and belief.
Complainant’s signature Date

Print or type name Address/Agency Telephone no.

CUSTODY Fill out completely


21. Basis for apprehension by police without court order 22. Check if applicable
The officer had reason to believe that because of the nature of the offense, the Miranda warning given    Attorney present
interest of the juvenile or the interest of the public would not be protected by release Offense admitted   Biometric data collected
of the juvenile. Offense denied   Photograph taken
Parent/guardian/legal custodian could not be located or refused to take custody of Parents/Guardian/Legal    Line-up held
the juvenile. custodian present

23. Release and recognizance


I acknowledge that the juvenile has been released to my custody, and I promise to bring the juvenile to the court upon
notice.

Date Signature Relationship to juvenile

NOTIFICATION TO PARENT, GUARDIAN, OR LEGAL CUSTODIAN


24. I notified or attempted to notify the person(s) listed below about the date, time, and place of the preliminary hearing. The method of contact or
attempted contact is described below and includes the date and time of notification for each.
25. Name notified Methods used Date Time
attempted
26. Name notified Methods used Date Time
attempted
27. Name notified Methods used Date Time
attempted
28. Name notified Methods used Date Time
attempted

ADDITIONAL COMMENTS

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