Fillable Temporary Custody Order Form (Page 2 of 4) in pdf

The responsible relative/guardian/custodian of the minor

has received notice and is present

has received notice and is not present

has not received notice and is present

has not received notice and is not present

Probable cause for the filing of the petition does not exist

Probable cause for the filing of the petition does exist based on the following facts:

______________________________________________________________________________

_______________________________________________________________________________

There is no immediate and urgent necessity to remove the minor from the home and leaving the minor

in the home is not contrary to the health, welfare and safety of the minor

There is immediate and urgent necessity to remove the minor from the home and leaving the minor

in the home is contrary to the health, welfare and safety of the minor based on the following facts:

______________________________________________________________________________

_______________________________________________________________________________

Reasonable efforts have not been made to keep the minor in the home

Reasonable efforts have been made to keep the minor in the home and they have eliminated the

immediate and urgent necessity to remove the minor

Reasonable efforts have been made to keep the minor in the home but they have not eliminated the

necessity for removal of the minor from the home and leaving the minor in the home is contrary to the

health, welfare and safety of the minor

Reasonable efforts, at this time, cannot prevent or eliminate the necessity for removal of the minor

from the home and leaving the minor in the home is contrary to the health, welfare and safety of the

minor

The following facts form the basis for this finding: _______________________________

______________________________________________________________________________

_________________________________________________________________________________

THEREFORE, it is the ORDER of this Court that:

The Petition is Dismissed.

The request for temporary custody is denied.

Temporary custody of the minor is given to:

_______________________________ who is the _____________________ of the minor

(N ame of person)

(R elationship of person)

The Guardianship Administrator of the Illinois Department of Children and Family Services

who is authorized to place the minor

________________________________________________________________________

(O ther agency)

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7/11/03

Page 2 of 4

Temporary Custody Order Form Page 2