STATE OF SOUTH CAROLINA COUNTY OF IN THE INTEREST OF
A Juvenile
) ) ) ) ) ) ) )
IN THE FAMILY COURT
AFFIDAVIT
PERSONALLY appeared before me, first being duly sworn, deposes and says that violated the terms of (his)/(her) probation (as ordered by the Family Court of County, S. C. on following facts: ,2
, who
) in the following particulars, and based on the
Sworn to and Subscribed before me day of , 2
Notary Public for South Carolina My Commission expires
) ) ) ) ) ) )
Signature of Affiant
SCCA/491 (9/1993)