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Here is the text we could read:

Filer’s Name

iler’s Address

ity, State, Zip

hone

mail

In the Juvenile Court of Utah

__________ Judicial District ________________ County

State of Utah, in the interest of:

Petition to be Removed from the
Custody of the Division of Child and
Family Services
Utah Code Section 78A-6-117(2)(c)(iv)

_____________________________________
(Minor’s Name)

_______________________________
Case Number

_____________________________________
(Minor’s Date of Birth)

_______________________________
Judge

My name is ______________________________________________________.

I am between the ages of 18 and 21. My birthdate is ______________________.

I want to be removed from the jurisdiction of the juvenile court and from the
custody of the Division of Child and Family Services.

I am under the custody of the Division of Child and Family Services because of
abuse, neglect or dependency.

[ ] The parental rights of my

[ ] father _____________________________________________ (name)

[ ] mother ____________________________________________ (name)

[ ] father _____________________________________________ (name)

[ ] mother ____________________________________________ (name)

have been terminated.

Petition to be Removed from the Custody of the
Division of Child and Family Services

Approved by Board of Juvenile Court Judges June 10, 2016
Revised August 9, 2018

Page 1 of 2

[ ] My parent’s / parents’ rights have not been terminated.

[ ] I have a court-appointed guardian:

___________________________________________ (guardian’s name).

My parent / parents or guardian agree that I should be removed from the custody
of the Division of Child and Family Services.

Minor’s signature

I declare under criminal penalty under the law of Utah that everything stated in this document is true.

Signed at ______________________________________________________ (city, and state or country).

arent’s / Guardian’s Signature

I agree that ___________________________________________ (minor’s name) should
be removed from the custody of the Division of Child and Family Services.

I declare under criminal penalty under the law of Utah that everything stated in this document is true.

Signed at ______________________________________________________ (city, and state or country).

arent’s / Guardian’s Signature

I agree that ___________________________________________ (minor’s name) should
be removed from the custody of the Division of Child and Family Services.

I declare under criminal penalty under the law of Utah that everything stated in this document is true.

Signed at ______________________________________________________ (city, and state or country).

Signature ►

Printed Name

Signature ►

Printed Name

Signature ►

Printed Name

Date

Petition to be Removed from the Custody of the
Division of Child and Family Services

Approved by Board of Juvenile Court Judges June 10, 2016
Revised August 9, 2018

Page 2 of 2

Petition to be Removed from the Custody of the Division of Child and Family Services

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah 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 legacy.utcourts.gov (2023-03)
Page(s): 2
Fields(s): 131
Average fields per page: 65
Reading Level: Grade 11
LIST Grouping(s): GO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

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.

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page_check__5 was page_1_check_1 (0.26 conf)

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

Petition to be Removed from the Custody of the Division of Child and Family Services

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

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