Name

County Attorney

Address

City, State, Zip

Telephone Number

Attorney for Plaintiff

IN THE YOUTH COURT

OF THE JUDICIAL DISTRICT OF THE STATE OF MONTANA

IN AND FOR THE COUNTY OF

*

IN THE MATTER OF * Cause No.

*

, * JUDGE

*

A YOUTH. * PETITION TO REVOKE

*

* * * * * * * * * * PROBATION

TO THE JUDGE OF THE YOUTH COURT OF THE JUDICIAL DISTRICT OF THE STATE OF MONTANA, IN AND FOR THE COUNTY OF

.

1. That the youth above named is (delinquent/in need of care/in need of supervision) because: On or about the day of , 19 , did violate Section of the Montana Code Annotated, to wit:

.

2. That the name, address and birth date of the above named youth is as follows: .

3. That the names and addresses of the parents of the above named youth are as follows: .

4. That the legal guardian (if there is one) is

, who resides at .

5. That , who resides at , has the actual custody and control of said youth.

6. That neither the father, mother, or legal guardian of the above named youth can be found, and the nearest known relative to the above named youth is , and is the (relationship) of the youth.

7. That the witnesses so far as is known to the petitioner are: .

8. That the above named youth is not in custody. (If in custody; date, time and location.) .

WHEREFORE, Petitioner prays that a day for hearing be set and that said youth be dealt with in accordance with the Youth Court Act of the State of Montana.

DATED this day of , 19 .

Petitioner

SUBSCRIBED AND SWORN TO before me this day of

, 19 .

Notary Public for the State of Montana

Residing at

My Commission expires

Let Summons issue, returnable, , 19 . at o'clock, .m.

Youth Court Judge