10-501A. Abuse and neglect party information sheet.
Abuse and Neglect Cases – Information Sheet
(File with Petition or Amended Petition)
Type or print responses. Required in all abuse and neglect cases.
THIS SECTION FOR OFFICIAL USE ONLY NOTE TO COURT CLERK: DOCKET EVENT CODE 9509, CRT: Abuse & Neglect Party Information Sheet. Scan document, but will not become part of the official record.
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Case number: _______ |
Assigned judge: _______ |
Children’s Court Attorney’s Name: __________________________________________
Person Completing Form: _________________________________________________
Phone Number: _______________________ E-mail: __________________________
New petition ________ Amended petition (enter new info only) ________
Enter as much of the following information as possible: |
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Minor Child 1 |
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Name (F, M, L) |
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Type of current placement* |
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Date of placement |
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Date of Birth |
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Special Conditions† |
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Respondent’s Relation to Minor Child** |
Respondent 1 |
Respondent 2 |
Respondent 3 |
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Minor Child 2 |
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Name (F, M, L) |
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Type of current placement* |
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Date of placement |
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Date of Birth |
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Special Conditions† |
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Respondent’s Relation to Minor Child** |
Respondent 1 |
Respondent 2 |
Respondent 3 |
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Minor Child 3 |
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Name (F, M, L) |
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Type of current placement* |
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Date of placement |
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Date of Birth |
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Special Conditions† |
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Respondent’s Relation to Minor Child** |
Respondent 1 |
Respondent 2 |
Respondent 3 |
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Add information for additional children as necessary. |
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* Type of placement: relative foster care; non-relative foster care; treatment foster care; residential treatment center; mental health facility/non-residential treatment center; juvenile justice facility
† Special Conditions: Indian Child Welfare Act (ICWA); Americans with Disabilities Act (ADA)
** Relation to Minor Child: Parent, custodian, guardian, other
Respondent 1 |
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Name (F, M, L) |
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Other Name (aka) |
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Address |
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Address |
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Date of Birth |
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Social Security Number |
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Special Conditions† |
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Respondent 2 |
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Name (F, M, L) |
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Other Name (aka) |
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Address |
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Address |
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Date of Birth |
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Social Security Number |
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Special Conditions† |
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Respondent 3 |
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Name (F, M, L) |
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Other Name (aka) |
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Address |
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Address |
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Date of Birth |
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Social Security Number |
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Special Conditions† |
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Add information for additional Respondents as necessary. |
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† Special Conditions: Indian Child Welfare Act (ICWA); Americans with Disabilities Act (ADA)
[Adopted by Supreme Court Order No. 14-8300-002, effective for all cases filed on or after August 31, 2014.]