PETITION
(DEPRIVATION)
IN THE JUVENILE COURT OF
__________________________ COUNTY, GEORGIA
In the interest of
_______________________________ SEX ____ AGE _____ DOB _________ CASE # ________________
_______________________________ SEX ____ AGE _____ DOB _________ CASE # ________________
_______________________________ SEX ____ AGE _____ DOB _________ CASE # ________________
_______________________________ SEX ____ AGE _____ DOB _________ CASE # ________________
A child/children under 18 years of age.
Your petitioner alleges the child(ren) named above to be of the sex(es) and age(s) and to have the name(s)
there set forth above; that the (putative) father of said child(ren) is __________________________, who
resides at ___________________________________________________________________; the mother is
_____________________________, who resides at __________________________________________; said
child(ren) reside(s) at ________________________________________________________________, in said
county and state, and is/are in the custody and control of _________________________, who resides at said
place; that the said child(ren) is/are subject to the jurisdiction of this Court; that said child(ren) is/are in need of
protection of this Court and is/are deprived (O.C.G.A. §15-11-2(8)) due to the following condition(s):
That said child(ren) was/were (not) taken into custody under the provisions of O.C.G.A. §15-11-45(a)(4).
That it is in the best interest of the child(ren) and the public that this proceeding be brought.
That said child(ren) is/are, is not/are not currently in shelter care facilities under the supervision of the
______________________________________ County Department of Family and Children Services, having
20_____.
been placed there at ____m., on ____________________________________,
Petitioner prays that process issue, directed to the parties hereto, requiring them to appear before this Court
to answer the allegations of this petition.
___________________________________
(Petitioner)
Subscribed and sworn to before me, on information and belief this ______________ day of
20_____.
_________________________________,
___________________________________
(Attesting Officer)
The above petition is approved to be filed in the best interest of the public and the named child(ren).
This ______ day of ______________________________, 20______.
__________________________________
(Court Designee)
Rev. 01/2001
JUV-4