AFFIDAVIT AND PETITION FOR PLACEMENT IN SHELTER
COMES NOW, the undersigned, who being first duly sworn says:
..... The child(ren) was/were taken into custody by ...........
..... The child(ren) need(s) to be taken into protective custody.
Name | Birth date | Sex Special Needs | Address |
.......................... | .......................... | .......................... | .......................... |
.......................... | .......................... | .......................... | .......................... |
.......................... | .......................... | .......................... | .......................... |
Name | Relationship | Address |
.......................... | .......................... | .......................... |
.......................... | .......................... | .......................... |
Name | Manner Notified |
.......................... .......................... | |
.......................... .......................... | |
.......................... .......................... |
.....(list).....is
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 Families;
..... at the home of a responsible adult relative, .....(name)....., whose address is ...............;
..... other.
____________________
Moving Party
____________________
.....(attorney's name).....
.....(address and telephone number).....
E-mail address: ..........
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.
COMMENT: The following paragraph must be in bold, 14 pt. Times New Roman or Courier font.
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)..... at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days. If you are hearing or voice impaired, call 711.
Fl. R. Juv. P. form 8.960