AFFIDAVIT
STATE OF FLORIDA
COUNTY OF ....................
Before me, the undersigned authority, personally appeared affiant, who, being sworn, made the following allegation of facts: .................... and requested that the court issue an order to take into custody the below.....named/described.....children.
Name(s) ....
Age(s) ....Sex ....
Date(s) of Birth ....
Race ....
Address ....
Identifying Description ....
Parent/Custodian....
Address .....
________________________
Affiant
_________________________
.....Address.....
Fl. R. Juv. P. form 8.904