Complaint - Youth In Crisis {JD-JM-142}

<document>COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.COMPLAINTYOUTH IN CRISISSTATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS www.jud.state.ct.us JUDICIAL SUBPOENAJD-JM-142 Rev. 9-02 C.G.S. § 46b-120, 46b-121, 46b-150f Public Act 02-109, Sec. 1Calendar No.Plaintiff(s) -against-Defendant(s)PRINT OR TYPE. If necessary, attach additional information.ADDRESS OF COURTDOCKET NO.DATE OF BIRTH TO: The Superior Court, Juvenile MattersSEXNAME OF YOUTHADDRESS OF YOUTHNAME OF MOTHERADDRESS OF MOTHER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NAME OF FATHERADDRESS OF FATHERNAME OF GUARDIAN, IF ANYADDRESS OF GUARDIANTHE PEOPLE OF THE STATE OF NEW YORK TOSCHOOL/GRADEINDIAN TRIBE/RESERVATION, IF ANYCOMPLAINTGREETINGS:The undersigned believes that the above youth is a youth in crisis because said youth is sixteen or seventeen years of age, and, within the last two years: ("X" appropriate box(es))WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,has without just cause run away from the parental home or other properly authorized and lawful place of abode; is beyond the control of parents, guardian or other custodian; OR has four unexcused absences from school in any one month or ten unexcused absences in any school year.located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomFor each box checked above, describe in detail the acts or omissions of said youth upon which the complaint is made. (Be specific and include dates.)Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:COMPLAINANT'S SIGNATUREDATE SIGNEDAGENCY AND TITLE (If applicable)Mobile Tel. No.:NOTICE: The youth may not be placed in detention based on this complaint.American LegalNet, Inc. www.USCourtForms.com</document>