State of Minnesota District Court County of Juvenile Court

In the Matter of the Welfare of: Name: first, middle, last	Master File No.	Prosecutor File No.
Petition No.
Date Initial Appearance
Probation Active Non-Active
Community of Offense	Race	Date of Birth	Amended
SID (State ID )	Group ID:	Prosecutor Designated EJJ
Alias Name(s):	ALIAS DATE(S) OF BIRTH:	Gender	Motion for EJJ Filed
Motion for Certification Filed
The child’s address, if different from parent, is as follows. Address: street, city, state, zip, and county	fingerprinting completed Yes No
photographing completed Yes No
Delinquency
The child’s parents, guardian, spouse or nearest relative, noting their relationship and address are as follows: Name: first, middle, last, relationship	Delinquency Felony (Age 16 an d Older)
Juvenile Petty Offense
Juvenile Traffic
Address: street, city, state, zip, and county	PETITION
if a driving offense	Driver’s License Number	Plate Number	Accident Type	if a DWI	Alcohol Concentration
Count	Offense Date	Statute	Statute Type	Text Description
*Offense Level	MOC at Filing	GOC	Controlling Agency	Control No.	Control Function
Count	Offense Date	Statute	Statute Type	Text Description
*Offense Level	MOC at Filing	GOC	Controlling Agency	Control No.	Control Function
Count	Offense Date	Statute	Statute Type	Text Description
*Offense Level	MOC at Filing	GOC	Controlling Agency	Control No.	Control Function
* Indicates Felony/Gross Misdemeanor/ Misdemeanor/ Petty
DATE FILED:

Count	Offense Date	Statute	Statute Type	Text Description
*Offense Level	MOC at Filing	GOC	Controlling Agency	Control No.	Control Function

Click the Button to Insert a New Table

Petitioner states to the Court that there is probable cause to believe that the child has committed the following described offense(s), based upon the following probable cause statement or the attached reports and exhibits:

I endorse this Petition as to form and verify that the contents are true to the best of my information and belief and that reasonable grounds exist to support the Petition. Assistant County Attorney Date	Subscribed and sworn to before me on Notary Public