Kentucky > Statewide > Dependency Neglect And Abuse
Juvenile Dependency Neglect And Abuse Petition DNA-1 - Kentucky
| Juvenile Dependency Neglect And Abuse Petition Form. This is a Kentucky form and can be used in Dependency Neglect And Abuse Statewide . |
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AOC-DNA-1 Rev. 1-11 Page 1 of 2 Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 610.010, 620.023, .027, .050, .060, .070, .080; FCRPP 20 COM M O NW E A LT H O F K E lex et justitia Case No._____________________ Court [] District [ ] Family County_______________________ Division ______________________ NT U C KY RT OF JUS TI JUVENILE DEPENDENCY, NEGLECT AND ABUSE PETITION CLERK'S USE ONLY Hearing Date __________________, 2______ Hearing Time ______________ [ ] a.m. [ ] p.m. Hearing Location ____________________________________________________________________________ __________________________________________________________________________________________ IN THE INTEREST OF: ____________________________________________________________________, A CHILD Birthdate Sex Race SSN Affiant,__________________________________________________________________________________, says that on ________________, 2_____, in _______________________ County, Kentucky, the above-named juvenile was/is [ ] dependent (UOR Code - 002813) [ ] neglected (UOR Code - 002814) [ ] abused (UOR Code - 002815) pursuanttoKRSChapter620etseqandwithinthescopeofKRS610.010(2)(d);Affiant'sgroundsofbeliefare:______ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Name of person believed responsible for neglect and/or abuse _________________________________________ Juvenile's Address: _______________________________________________________________________________________________ _______________________________________________________________________________________________ ________________________________________________________________ Telephone No. __________________ Juvenile attends school at __________________________________________________________________________ Affiant's Name (print) _____________________________________________________________________________ Affiant'sAddress_________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Telephone No. _____________________ Distribution: Court File Local DCBS Parent or other person exercising custodial control or supervision (sheriff to serve) Local CASA Project Director upon Court referral C CO U E American LegalNet, Inc. www.FormsWorkFlow.com AOC-DNA-1 Rev. 1-11 Page 2 of 2 Case No. ___________________ Juvenile's Legal Mother: _______________________________________________________________ Address: _____________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Phone No. _________________ SSN _____________________ Legal Custodian? [ ] Yes [ ] No Name of Other(s) Living in Mother's Home and relationship to Child: [ ] Stepfather ________________________________________________________________________ [ ] Sibling(s) ________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ [ ] Other ___________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Juvenile's Legal Father: _______________________________________________________________ Address: _____________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Phone No. _________________ SSN _____________________ Legal Custodian? [ ] Yes [ ] No Name of Other(s) Living in Father's Home and relationship to Child: [ ] Stepmother _______________________________________________________________________ [ ] Sibling(s) ________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ [ ] Other ___________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ [ ] Name and relation of other person exercising custody or control of child _____________________________ _____________________________________________________________________________________________ [ ] Name and address of nearest known adult relative if no parent or person exercising custodial control or supervision (PECC) is located: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Affiant states the foregoing allegations are true based upon information and belief. Affiant'sSignature______________________________________________________________________________ Sworn to before me on ___________________, 2_____. My Commission expires: _________________, 2_____. ______________________________________________ Name ______________________________________________ Title American LegalNet, Inc. www.FormsWorkFlow.com
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