Forms Generation Merge Doument

SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT 500 INDIANA AVENUE, NW WASHINGTON, D.C. 20001 ORDER FOR CUSTODY In the Matter of:

Child’s Name: Docket Number:

Birth Date: Sex: Race:

Address:

Attorney of Record: Telephone#: Place(s) Frequented: And or Regular Companion(s): Special Instructions: This matter comes before the Division on an application for an order for custody and it appears that: 1. There are reasonable grounds to believe that the above-named child: Has committed a delinquent act. Is suffering from illness or injury or is in immediate danger from his surroundings and must be Removed from those surrounds.

Has run away and absconded from CFSA custody on Has failed to appear as required for on

2. A summons issued by the Clerk and served by a law enforcement officer will not secure the presence of the child at a hearing. THEREFORE IT IS HERBY ORDERED THAT: Any law enforcement officer of the District of Columbia shall take the above-named child into custody at once and hall will all reasonable speed: Bring the child before the Court during business hours prior to 3:00 p.m.; Monday through Friday and prior to 2:30 p.m. on Saturday or take the child to the CPU cellblock after business hours for: Detention pending the next regularly scheduled session of Court. Determination of placement by the representative of the Director of Social Services pending appearance at the next regularly scheduled of Court. Contact Social Services Divisions, Intrafamily and Neglect Branch 202 724-2023 during business hours. Monday through Friday, 8:15a.m to 4:30 p.m., or contact 24-Hour Protective Services, Department of Human Services 202-671-7233, after business hours and on weekends and holidays.

Any law enforcement officer who takes a child into custody shall upon apprehension, give notice to the Deputy Clerk, Juvenile and Neglect Branch, Rom 4310, 500 Indiana Avenue, N.W., Washington, D.C. 20001.

Jurisdiction of the Court under any orders shall be extended and shall not expire while the above-named child is in abscondence.

______Date: Judge’s Signature I hereby certify and return that:

The order for custody was executed by me on and the child was taken to:

C.P.U Cell The DC Superior Court, Family Division, block or: other (Specify: and notice was given as required by item 2 of the order.

The order for custody has not been executed and is returned for the following reasons:

The order was issued more than one year ago.

The child is in custody by other process. Specify:

Remarks:

Date: Signature: STATEMENT OF FACTS SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT AFFIDAVIT AND REQUEST FOR CUSTODY ORDER

RESPONDENT: DOB: RESPONDENT’S ALIAS: RESPONDENT’S ADDRESS: RESPONDENT’S DESCRIPTION:

SOCIAL WORKER:

COMPLAINT:

______SIGNATURE OF AFFIANT

Sworn to before me this ______day of______, 2012

______Assistant Attorney General, D.C.

Upon consideration of the foregoing, the Attorney General request that the Court, pursuant to its authority under CR- Neglect 4, issue an order for custody of the above-named juvenile.

______Assistant Attorney General, D.C.