8.960 Shelter Petition

AFFIDAVIT AND PETITION FOR PLACEMENT IN SHELTER

COMES NOW, the undersigned, who being first duly sworn says:

1. On .....(date)..... at .......... a.m./p.m. the above named minor child(ren) was/were found within the jurisdiction of this court.

..... The child(ren) was/were taken into custody by ...............................

..... The child(ren) need(s) to be taken into protective custody.

2. The name, age, and residence of this/these child(ren) is/are:

Name            Birth date   Sex     Address

.................... ............... .......... ......................
.................... ............... .......... ......................
.................... ............... .......... ......................

3. The name, relationship to the child(ren), and address of the child(ren)’s parents or other legal custodian(s) is/are:

Name             Relationship    Address

..................... ..................... ....................
..................... ..................... ....................

4. The following individuals who were listed in #3 above have been notified in the following manner of the date, time, and location of this hearing:

Name                             Manner Notified

..................................... .....................................
..................................... .....................................
..................................... .....................................

The following individuals who were listed in #3 above have not been notified of this hearing:

Name                             Reason

..................................... .....................................
..................................... .....................................
..................................... .....................................
5. There is probable cause that the child(ren)

..... a. has/have been abused, abandoned, or neglected or is/are in imminent danger of illness or injury as a result of abuse, abandonment, or neglect;

..... b. was/were with a parent or legal custodian who has materially violated a condition of placement imposed by the court;

..... c. has/have no parent, legal custodian, or responsible adult relative immediately known and available to provide supervision and care; because ....................

6. The provision of appropriate and available services will not eliminate the need for placement of the child(ren) in shelter care because:

..... a. an emergency existed in which the child(ren) could not safely remain in the home;

..... b. the home situation presents a substantial and immediate danger to the child(ren) which cannot be mitigated by the provision of preventive services;

..... c. the child(ren) could not be protected in the home despite the provision of the following services and efforts made by the Department of Children and Family Services to prevent or eliminate the need for placement in shelter care:

..... d. The child(ren) cannot safely remain at home because there are no preventive services that can ensure the safety of the child(ren).

7. The child(ren) is/are in need of and the petitioner requests the appointment of a guardian ad litem.

8. The petitioner requests that the parents, if able, be ordered to pay fees for the care, support, and maintenance of the child(ren) as established by the department under chapter 39, Florida Statutes.

9. The petitioner requests that the parents be ordered to provide to the Department of Children and Family Services and the Department of Revenue financial information necessary to accurately calculate child support under section 61.30, Florida Statutes, within 28 days of this order.

10. This affidavit and petition is filed in good faith and under oath.

WHEREFORE, the affiant requests that this court order that this/these child(ren) be placed in the custody of the department until further order of this court and that the place of such custody shall be:

..... at the discretion of the Department of Children and Family Services;

..... at the home of a responsible adult relative, ............
.................................................., whose address is .....
.................................................................................

..... other .......................................................................
.................................................................................

__________________
Moving Party

.....attorney’s name.....
.....address and telephone number.....
.....Florida Bar number.....

Verification

NOTICE TO PARENTS/GUARDIANS/LEGAL CUSTODIANS

A date and time for an arraignment hearing is normally set at this shelter hearing. If one is not set or if there are questions, you should contact the Juvenile Court Clerk’s office at ................. A copy of the Petition for Dependency will be given to you or to your attorney, if you have one. A copy will also be available in the clerk’s office. You have a right to have an attorney represent you at this hearing and during the dependency proceedings and an attorney will be appointed for you if you request an attorney and the court finds that you are unable to afford an attorney.

If you are a person with a disability who needs any accommodation to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact .....(name, address, telephone number)..... within two working days of your receipt of this summons. If you are hearing or voice impaired, call 711.