Approved, SCAO
JIS CODE: DSP
STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY
Court address ORI MI-
ORDER OF DISPOSITION, IN-HOME (DELINQUENCY PROCEEDINGS)
CASE NO. PETITION NO.
Court telephone no.
CTN/TCN
SID
DOB
1. In the matter of
name(s), alias(es)
2. Date of hearing: Judge/Referee: Bar no. 3. Notice of hearing was given as required by law. 4. The juvenile has appeared in court in person with parent(s), guardian, legal custodian, guardian ad litem, and was represented by an attorney. waived representation by an attorney. 5. The court determined that the juvenile committed the following offense(s) and/or the following offense(s) has/have been dismissed:
ADJUDICATED BY DISMISSED BY* Count Plea* Court Jury ALLEGATIONS CHARGE CODE(S) MCL Citation/PACC Code
*For plea, insert "A" for admission or "NC" for nolo contendere. For dismissal, insert "D" for dismissed by court or "NP" for dismissed by prosecutor/plaintiff.
6. Specific findings of fact and law regarding this proceeding have been made on the record.
7.
HIV testing and sex offender registration is completed. Chemical testing for DNA identification profiling is completed. 8. The juvenile has been fingerprinted according to MCL 28.243. 9. The offense is abstractable to the Secretary of State (pursuant to MCL 257.625[20][a], 257.732, 324.80131, 324.81134[12], 324.81135[7], 324.82157, 333.7408a[12], or 436.1703). The juvenile's driver's license number is . 10. The licensing sanction is reportable to the State Police (pursuant to MCL 333.7408a[12] or 257.625[20][b]). Revoked. Suspended days. Restricted days. IT IS ORDERED: 11. is warned and the petition is dismissed.*
Name (type or print)
12. The juvenile is placed on
specify type
probation in the home of
.
13. Other: (Include reimbursement as required by MCL 712A.18[2] or as permitted by MCL 769.1f.)
14. Juvenile shall pay
$20.00 for Crime Victim's Rights Fund.
State minimum costs .
specify for each count
.
15. The review date is 16. The petition is dismissed.* Recommended by:
Date Referee signature Judge
*Note: Check 11 only if all or some of the material allegations are sustained. Check 16 only if all of the material allegations are not sustained. Do not write below this line - For court use only
Upon disposition of a juvenile offense as defined pursuant to MCL 28.241a(f), the clerk of the court shall advise the Michigan State Police Criminal Justice Information Center of the disposition as required by MCL 712A.18(11).
JC 14a (9/08)
ORDER OF DISPOSITION, IN-HOME (DELINQUENCY PROCEEDINGS)
MCL 28.241a, MCL 600.2950h, MCL 600.2950m, MCL 712A.18, MCL 712A.18k, MCL 712A.20, MCL 764.15b, MCL 769.1f, MCL 769.16a, MCR 3.936, MCR 3.943