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STATE OF MICHIGAN

JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY

PETITION
(DELINQUENCY PROCEEDINGS)

Amended

Supplemental

CASE NO.

PETITION NO.

JUDGE

Court Address

Court telephone no.

CTN

TCN

SID

DOB

DLN

A sample for chemical testing for DNA identification profiling is on file with the Michigan State Police from a previous petition.

In the matter of

First and last name(s), alias(es)

1. The above named juvenile
Citations and allegations:

comes within the provisions of MCL 712A.2.

operator/chauffeur driver's license

commercial driver's license

has violated probation as follows:
|

no license vehicle type

See attached sheet for further allegations.

Member of or eligible for membership in an Indian tribe, as stated above.

a. There are no pending or resolved cases within the jurisdiction of the family division of the circuit court involving the

family or family members of the person(s) who are the subject of the petition.

b. There is one or more pending or resolved cases within the jurisdiction of the family division of the circuit court
involving the family or family members of the person(s) who are the subject of the petition. I have separately filed
a completed confidential case inventory (form MC 21) listing those cases.

c. It is unknown if there are pending or resolved cases within the jurisdiction of the family division of the circuit court

involving the family or family members of the person(s) who are the subject of the complaint.

3. I designate this case as a case in which the juvenile is to be tried in the same manner as an adult.

4. The juvenile named above is a legal resident of

care and custody of

County, and resides in the

5. The names and addresses of the parents, guardian, legal custodian, or nearest known relative are as follows:

NAME

ADDRESS

HOME PHONE

WORK PHONE

Father Putative

Mother

Guardian/Legal custodian/Nearest known relative

Approved, SCAO
Form JC 04a, Rev. 3/23
MCL 600.2950h-600.2950m, MCL 712A.2, MCL 712A.2d, MCL 764.15b,
MCR 3.903(A), MCR 3.926(A), MCR 3.931, MCR 3.944, MCR 3.951
Page 1 of 2

JIS Code: PETORIMI-Petition (Delinquency Proceedings)
Page 2 of 2

(3/23)

Case No.

6. I request the court to (check either box a or b)

a. review the information and make an appropriate decision.

b. authorize this petition and take jurisdiction over the juvenile. Further, I request the court to

1) issue an order to apprehend and/or detain the juvenile.
2) find the juvenile in contempt of court for violating a minor personal protection order.
3) find the juvenile has violated probation and

notify the juvenile to appear for the hearing.
order the juvenile apprehended and brought to court for a detention hearing.

4) designate this case as a case in which the juvenile is to be tried in the same manner as an adult.

I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best
of my information, knowledge, and belief.

Petitioner’s signature Date

Print or type name

Agency/Address

City, state, and zip Telephone no.

7. I approve this petition for submission.

I agree to have this petition placed on the consent calendar.

Date

Prosecutor’s signature

8. A preliminary inquiry and/or hearing has been conducted and the filing of this petition

is not

authorized.

Judge/Referee signature and date

JC 04a, Petition (Delinquency Proceedings)

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.courts.michigan.gov/juvenile-proceedings (2023-03)
Page(s): 2
Fields(s): 65
Average fields per page: 32
Reading Level: Grade 11
LIST Grouping(s): CO-07-00-00-00, CO-00-00-00-00.

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

stat_e_n_l_county was STATE OF MICHIGAN JUDICIAL CIRCUIT FAMILY DIVISION COUNTY (0.64 conf)
amended was Amended (0.35 conf)
ctn was CTN (0.42 conf)
tcn was TCN (0.44 conf)
sid was SID (0.35 conf)
users1_birthdate was DOB (1.00 conf)
dln was DLN (0.35 conf)
sample_testing_previous was A sample for chemical testing for DNA identification profiling is on file with the Michigan State Police from a previous petition (0.42 conf)
first_last_names_aliases was First and last names aliases (0.40 conf)
comes_within_provisions_mc_l was comes within the provisions of MCL 712A2 (0.42 conf)
violated_probation_follows was has violated probation as follows (0.40 conf)
drivers_license was operatorchauffeur drivers license (0.53 conf)
commercial_drivers_license was commercial drivers license (0.48 conf)
license was no license (0.48 conf)
member_eligible_stated was Member of or eligible for membership in an Indian tribe as stated above (0.38 conf)
see_attached_sheet was See attached sheet for further allegations (0.37 conf)
resolved_cases_jurisdiction was a There are no pending or resolved cases within the jurisdiction of the family division of the circuit court involving the (0.39 conf)
one_cases_within was b There is one or more pending or resolved cases within the jurisdiction of the family division of the circuit court (0.39 conf)
c_unknown_pending_resolved_cases_within_jurisdiction_family_division_circuit_court was c It is unknown if there are pending or resolved cases within the jurisdiction of the family division of the circuit court (0.39 conf)
designate_juvenile_manner_adult__1 was 3 I designate this case as a case in which the juvenile is to be tried in the same manner as an adult (0.40 conf)
county_resides was County and resides in the (0.35 conf)
undefined was undefined_2 (0.39 conf)
putative was Putative (0.38 conf)
address_father_putative was ADDRESSFather Putative (0.37 conf)
hom_e_phone_father_putative was HOME PHONEFather Putative (0.45 conf)
wor_k_phone_father_putative was WORK PHONEFather Putative (0.53 conf)
address_mother was ADDRESSMother (0.37 conf)
hom_e_phone_mother was HOME PHONEMother (0.51 conf)
wor_k_phone_mother was WORK PHONEMother (0.47 conf)
address_known_relative was ADDRESSGuardianLegal custodianNearest known relative (0.42 conf)
phone_custodian_nearest_known was HOME PHONEGuardianLegal custodianNearest known relative (0.48 conf)
phone_custodian_known_relative was WORK PHONEGuardianLegal custodianNearest known relative (0.50 conf)
county was County (0.39 conf)
supplemental was Supplemental (0.36 conf)
checkbox was Checkbox1 (0.35 conf)
petition was Petition no (0.49 conf)
judge was Judge (0.39 conf)
court_telephone was Court telephone no (0.51 conf)
court_address was Court address (0.42 conf)
text__1 was Text30 (0.35 conf)
text__2 was Text31 (0.35 conf)
text__3 was Text32 (0.35 conf)
text__4 was Text33 (0.35 conf)
text__5 was Text34 (0.35 conf)
text__6 was Text35 (0.35 conf)
text__7 was Text36 (0.35 conf)
review_information_appropriate was a review the information and make an appropriate decision (0.35 conf)
petition_take_request was b authorize this petition and take jurisdiction over the juvenile Further I request the court to (0.40 conf)
apprehend_detain_juvenile was 1 issue an order to apprehend andor detain the juvenile (0.36 conf)
contempt_minor_personal was 2 find the juvenile in contempt of court for violating a minor personal protection order (0.38 conf)
find_violated_probation was 3 find the juvenile has violated probation and (0.35 conf)
designate_juvenile_manner_adult__2 was 4 designate this case as a case in which the juvenile is to be tried in the same manner as an adult (0.39 conf)
juvenile_appear_hearing was notify the juvenile to appear for the hearing (0.32 conf)
apprehended_brought_hearing was order the juvenile apprehended and brought to court for a detention hearing (0.42 conf)
signature_date__1 was Date (1.00 conf)
print_type_name was Print or type name (0.45 conf)
agency_address was AgencyAddress (0.44 conf)
city_state_zip was City state and zip (0.38 conf)
telephone was Telephone no (0.44 conf)
petition_placed_consent was I agree to have this petition placed on the consent calendar (0.41 conf)
signature_date__2 was Date_2 (1.00 conf)
is was is (0.32 conf)
is_not was is not (0.34 conf)
text__8 was Text37 (0.35 conf)
text__9 was Text38 (0.35 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

JC 04a, Petition (Delinquency Proceedings)

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02