COMPLAINT/REFERRAL IN THE JUVENILE COURT OF PAULDING COUNTY, GEORGIA

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1 COMPLAINT/REFERRAL IN THE JUVENILE COURT OF PAULDING COUNTY, GEORGIA (last, F, M) Case# File # AKA: DOB: Race: Lives Telephone: Res.: Sex: With: Telephone: Bus.: Child's (Street) (Apt#) (City) (County) (State) (Zip) Age: Mother's : (include Mother's Maiden in Parenthesis) Telephone: Res.: Telephone: Bus.: Mother's Father s : Father's Legal Custodian (Street) (Apt#) (City) (County) (State) (Zip) Telephone: Res.: Telephone: Bus.: (Street) (Apt#) (City) (County) (State) (Zip) Telephone: Res.: Telephone: Bus.: Custodian's Complaint: Complaint: Complaint: (Street) (Apt#) (City) (County) (State) (Zip) (Code Section) (Misd/Fel) (Date of Offense) (Code Section) (Misd/Fel) (Date of Offense) (Code Section) (Misd/Fel) (Date of Offense) Taken Into Custody Yes ( ) No ( ) By Whom: () (Agency) Placement of Deprived Child Date: Time: Person Notified Date: By: Via: Time: Detained: Yes ( ) No ( ) Place Date: Authorized by: Detained Time: Released To: Relation: Date: Time: Co-Perpetrators: ( and Age) Co-Perpetrators: ( and Age) Victim's Phone # Victim's : Victim's Phone # Victim's : Page 1 of 2 Pages

2 of Child Give Complete Details of Offense(s) or Complaint(s) and Apprehension: Agency: Investigating Officer: P.D. Report # Phone # Complainant's : Complainant's : Signature(s): Date Phone: Page 2 of 2 Pages

3 IN THE JUVENILE COURT OF PAULDING COUNTY STATE OF GEORGIA In RE: ) CASE NUMBER: A minor child. ) PETITION FOR EMANCIPATION NOW COMES the above-named minor, a resident of the State of Georgia, at least 16 years of age, who shows this Court pursuant to O.C.G.A et seq., that he/she declares his/her intention to be declared emancipated, as follows: 1) The Minor s: Length of residency at that address 2) The Minor s date of birth is AND a certified copy of the minor s birth certificate is attached hereto. 3) The Minor s parents /guardians full names and addresses is/are: Or, if no parent or guardian can be found, the name and address of the Minor s nearest living relative residing within this state is: Relationship

4 4) The Minor has demonstrated the ability to manage his or her financial affairs, including proof of employment or other means of support (not including general assistance or aid received from public assistance programs including but not limited to TANF or Title IV-A of the Social Security Act), as follows:. 5) The Minor has demonstrated the ability to manage his or her personal and social affairs, including but not limited to proof of housing, as follows:. 6) The names, addresses and telephone numbers who have personal knowledge of the Minor s circumstances and believe that under those circumstances emancipation is in the best interest of the minor, and will provide an affidavit to that effect: Relationship / how minor is known to the adult Relationship / how minor is known to the adult

5 Relationship / how minor is known to the adult 7) The Minor shows that (check one): The parents or guardian do(es) not object to the petition, or The parents or guardians object, but the child s best interest is served by allowing the emancipation; WHEREFORE, the Minor child requests the Court conduct a hearing, and thereafter issue an emancipation order, finding that the minor has met the burden of proof by a preponderance of the evidence that emancipation is in the best interests of the child, AND That the child be considered to have the rights and responsibilities of an adult, except for those specific constitutional and safety regulations relevant to the minor because of his or her age, the rights of a minor to receive any transfer of property or money pursuant to The Georgia Transfers to Minors Act under Article 5 of Title 44, under the Uniform Transfers to Minors Act, the Uniform Gift to minors Act, or other substantially similar act or another state, or pursuant to a trust agreement, AND The Minor should be considered emancipated for the purposes of, but not limited to: (1) The right to enter into enforceable contracts, including apartment leases; (2) The right to sue or be sued in his or her own name; (3) The right to retain his or her own earnings; (4) The right to establish a separate domicile; (5) The right to act

6 autonomously, and with the rights and responsibility of an adult, in all business relationship, including, but not limited to, property transactions, and obtaining accounts for utilities, except for those estate or property matters that the court determines may require a conservator or guardian ad litem; (6) The right to earn a living, subject only to the health and safety regulations designed to protect those under age 18 regardless of their legal status (i.e., can still be convicted of underage possession of alcohol); (7) The right to authorize his or her own preventative health care, medical care, dental care, and mental health care, without parental knowledge or liability; (8) The right to apply for a driver s license or other state licenses for which he or she might be eligible; (9) The right to register for school; (10) The right to apply for medical assistance programs and for other welfare assistance, if needed; (11) the right, if a parent, to make decisions and give authority in caring for his or her own minor child; and (12) the right to make a will. This day of, 20. Minor child Attorney for the Minor Child

7 County of Paulding State of Georgia VERIFICATION I hereby verify that the facts alleged in the above-styled petition are true and correct to the best of my knowledge. This day of, 20. MINOR CHILD Sworn to and subscribed before me this the day of, 20. NOTARY PUBLIC

8 County of Paulding State of Georgia PARENT/GUARDIAN CONSENT TO EMANCIPATION CAME BEFORE the undersigned officer duly authorized to administer oaths the affiant who says under oath as follows: 1) I am the parent or guardian of, a minor child seeking emancipation. 2) I understand that, if emancipated, the child shall be considered to have the rights and responsibilities of an adult, except for those specific constitutional and safety regulations relevant to the minor because of his or her age, the rights of a minor to receive any transfer of property or money pursuant to The Georgia Transfers to Minors Act under Article 5 of Title 44, under the Uniform Transfers to Minors Act, the Uniform Gift to Minors Act, or other substantially similar act or another state, or pursuant to a trust agreement. 3) I understand further that the Minor shall be considered emancipated for the purposes of, but not limited to: (1) The right to enter into enforceable contracts, including apartment leases; (2) The right to sue or be sued in his or her own name; (3) The right to retain his or her own earnings; (4) The right to establish a separate domicile; (5) The right to act autonomously, and with the rights and responsibility of an adult, in all business relationship, including, but not limited to, property transactions, and obtaining accounts for utilities, except for those estate or property matters that the court determines may require a conservator or guardian ad litem; (6) The right to earn a living, subject only to the health and safety regulations designed to protect those under age 18 regardless of their legal status (i.e., can still be convicted of underage possession of alcohol); (7) The right to authorize his or her own preventative health care, medical care, dental care, and mental health care, without parental knowledge or liability; (8) The right to apply for a driver s license or other state licenses for which he or she might be eligible; (9) The right to register for school; (10) The right to apply for medical assistance programs and for other welfare assistance, if needed; (11) The right, if a parent, to make decisions and give authority in caring for his or her own minor child; and (12) The right to make a will. I CONSENT TO THIS EMANCIPATION. Sworn to and subscribed before me this day of, 20. NOTARY PUBLIC Signature of Parent or Guardian

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