Free CCJP0665 - Illinois

(Rev. 6/14/01) CCJP 0665 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS DEPARTMENT OF JUVENILE JUSTICE AND CHILD PROTECTION CHILD PROTECTION DIVISION

REQUEST FOR CHILD PROTECTION WARRANT

DOCKET/WARRANT NUMBER _________________________ DATE ____________________ TO THE CLERK OF THE COURT: I have requested a Child Protection Warrant in the interests of: NAME _____________________________ SEX _____ RACE_______________ AGE ______

_____/______/______ RESIDENCE _________________________________________ APT./FLR. # _________ SCHOOL OR EMPLOYMENT _______________________________________________ TEMPORARY CUSTODIAN'S NAME ___________________________________________ ADDRESS ______________________________ TELEPHONE (_____)_______________ MOTHER'S NAME _________________________________________________________ ADDRESS ______________________________ TELEPHONE (_____)_______________ FATHER'S NAME __________________________________________________________ ADDRESS ______________________________ TELEPHONE (_____)_______________ REQUESTER _____________________________ AGENCY __________________________ TELEPHONE (_____)___________________ PETITION CHARGES _______________________________________________________ ADDITIONAL INFORMATION _________________________________________________ ___________________________________________________________________________ ____________________________________________________________________________
DESTINATION: IDCFS _____________ OTHER ____________________________________ (APPLICABLE ONLY IF TAKEN INTO CUSTODY WHEN COURT IS NOT IN SESSION) RETURN COURT DATE(S) _____________________________________________________ JUDGE _______________________________ CALENDAR _________ CPD YD# __________ NAME NO. (IF APPLICABLE) BY ORDER OF: PRESIDING JUDGE, CHILD PROTECTION DIVISION DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
Rev. 7/95

HEIGHT ____________ WEIGHT ____________ DATE OF BIRTH