ࡱ> gif7 !bjbjUU B^7|7|>lnnnnnnn$P4Dx1- :8>L, , , , , , ,$- 0b.,n222.,nn,2nn,2,$&|nn4' f RH'4'-01-"'i0i04'nnnnSEC. 732, FCA FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ROCKLAND IN THE MATTER OFFORM 7-7 (Delinquency  Supervision) Rev. 5/74 Docket No. _______________________ FORMTEXT      PETITIONa Person Alleged to be in Need of Supervision,(PERSON IN NEED OF SUPERVISION)Respondent. TO THE FAMILY COURT: The undersigned Petitioner shows that: Petitioner,  FORMTEXT      , resides at  FORMTEXT      , New York. Petitioner is a person authorized to institute a proceeding under Article 7 of the Family Court Act by reason of the fact that  FORMTEXT       is  FORMTEXT      . Respondent is a  FORMTEXT       person who was born on  FORMTEXT       and resides at  FORMTEXT      , New York. The following are the names and addresses of the parents or other persons legally responsible for the care of the Respondent or with whom the Respondent is domiciled: NameResidenceRelationship FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       5. (Upon information and belief,) Respondent is:  FORMCHECKBOX  not attending school in accord with the provisions of part one of Article 65 of the Education Law  FORMCHECKBOX  incorrigible  FORMCHECKBOX  ungovernable  FORMCHECKBOX  habitually disobedient and beyond the lawful control of  FORMTEXT       parents, guardian or lawful custodian, in that  FORMTEXT       (set forth a concise statement of the acts on which the foregoing allegations are based and the time and place they allegedly occurred):  FORMTEXT       6. Said Respondent was under sixteen (eighteen) years of age at the time of the foregoing acts. 7. Said Respondent requires supervision, treatment or confinement. 8. As to the allegations herein made upon information and belief, the sources of Petitioners information and grounds of belief are the statements and admissions of Respondent, if any, and the statements and depositions of witnesses, if any, on file with the Court. WHEREFORE, Petitioner prays that the Respondent be adjudged a person in need of supervision and dealt with in accordance with Article 7 of the Family Court Act. Dated: FORMTEXT       FORMTEXT      , Petitioner VERIFICATION STATE OF NEW YORK ) ) SS.: COUNTY OF ROCKLAND )  FORMTEXT      , above named being duly sworn, says: I am the Petitioner in the foregoing petition, said petition is true to my own knowledge, except as to the matters therein stated to be alleged on information and belief, and that as to those matters, I believe it to be true. ___________________________________  FORMTEXT      , Petitioner Sworn to before me this  FORMTEXT       day of  FORMTEXT      , 20 FORMTEXT       ________________________________ Notary Public PETITION REPORT TO THE FAMILY COURT REASON FOR PETITION: FORMCHECKBOX  Warrant & Return FORMCHECKBOX Ineligible Unsuitable FORMCHECKBOX Terminated without adjustment Respondent: FORMTEXT      Docket #: FORMTEXT      Date of Complaint: FORMTEXT      Date of Preliminary Intake Review: FORMTEXT      Date of DAS Referral: FORMTEXT      Date of (90) Day Extension: FORMTEXT      Type of Complaint: FORMCHECKBOX  Truancy  FORMCHECKBOX  Runaway  FORMCHECKBOX  Incorrigibility  FORMCHECKBOX  Marijuana FORMCHECKBOX  Other:  FORMTEXT      Summary of Intake Actions: FORMTEXT      Case Treatment Plan: FORMTEXT      Service Provider Referrals: FORMTEXT      Barriers to Successful Adjustment: FORMTEXT      Recommendations to the Court: FORMTEXT      Submitted by:Title: FORMTEXT      Approved by:Date Submitted: FORMTEXT       PAGE 1 PAGE 3  FILENAME Prob_Pins_Petition.dot VZB8:NPR\^bxz   4 6 J L N X Z ͶܬͶܢͶܘͶjFCJUjCJUj\CJUjCJUmHnHujCJU jCJUjtUCJjUmHnHujU jU5CJ5CJ<j>RTVXZX$If $$Ifa$B$$Ifl0|)4 la $$Ifa$$&dIfP$Ifz!!B,h@8_ $$Ifa$D$$Ifl40|)4 la$IfD$$Ifl40|)4 la $$Ifa$     ( v x $$Ifa$ & F &dPD$$Ifl40|)4 la      & ( , . 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