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Petition Obstruction Of Or Interference With Juvenile Investigation Abuse Neglect Dependency J-120 - North Carolina
| Petition Obstruction Of Or Interference With Juvenile Investigation Abuse Neglect Dependency Form. This is a North Carolina form and can be used in Juvenile Statewide . |
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File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Court Division IN THE MATTER OF: Name And Address Of Juvenile PETITION OBSTRUCTION OF OR INTERFERENCE WITH JUVENILE INVESTIGATION Juveniles Date Of Birth Age Race Sex (ABUSE/NEGLECT/DEPENDENCY) Social Security No. Of JuvenileName Of Petitioner G.S. 7B-303Name And Address Of Respondent 1 Name And Address Of Respondent 2 I have sufficient knowledge or information to believe that a case has arisen that invokes the juvenile jurisdiction of the court, and therefore allege that: 1. On or about (date) , the Department of Social Services (DSS) of the county named above received a report of abuse, neglect or dependency concerning the juvenile named above, which requires an investigation as set forth in G.S. 7B-303. 2. The name, addresses and telephone numbers of the juveniles parents, guardian, custodian, or caretaker are as follows: NAME RELATIONSHIP OR TITLE ADDRESS TELEPHONE 3. Respondent(s), without lawful cause, has obstructed and/or interfered with the investigation. The obstruction and/or interference consists of the following: a. refusal to disclose the whereabouts of the juvenile. b. refusal to allow personal access to the juvenile. c. refusal to allow observation and/or interview of the juvenile in private. d. refusal to allow access to confidential information and/or records after proper request by DSS pursuant to G.S. 7B-303. e. refusal to allow DSS to arrange for an evaluation of the juvenile by a physician or other expert. f. other conduct which makes it impossible for DSS to carry out its duty to investigate. (specifically describe respondents conduct) 4. There is reason to believe that the juvenile is in need of immediate protection and/or assistance. The basis for that belief is as follows: AOC-J-120, New 7/99 1999 Administrative Office of the Courts (See ADDITIONAL ALLEGATIONS on Reverse) <<<<<<<<<********>>>>>>>>>>>>> 2 WHEREFORE, the Petitioner prays for the following relief: 1. That the Court hear this case and determine that the allegations are true. 2. That the Court enter an order directing the respondent(s) to cease obstructing or interfering with the investigation. 3. That the Court issue an immediate ex parte order directing the respondent(s) to cease such obstruction or interference. 4. For such other and further relief as the Court deems just and proper. VERIFICATION Being first duly sworn, I say that I have read this Petition and that the same is true to my own knowledge, except as to those matters alleged upon information and belief, and as to those, I believe it to be true. Signature Of Petitioner SWORN AND SUBSCRIBED TO BEFORE ME Date Signature Of Person Authorized To Administer Oaths Director Authorized Representative of Director Address County Department of Social Services Deputy CSC Assistant CSC Clerk Of Superior Court Date My Commission Expires City, State, Zip Telephone No. SEAL Notary AOC-J-120, Side Two, New 7/99 1999 Administrative Office of the Courts
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