In the Court of Common Pleas, Juvenile Division Lorain County, Ohio

COMPLAINT    
		Case #      	
		
		Judge      
   		
State of Ohio
	
	v			    

          
Defendant      

	The undersigned, after being duly sworn, according to law, says that he/she has knowledge that

During a period of time between         ,        in Lorain County, Ohio, being the parent, guardian, or other person having care of ,        a child of compulsory school age, did violate any provision of Section 3321.01, 3321.03, 3321.04, 3321.07 or 3321.10, 3321.19, 3321.20 or 3331.14 of the Ohio Revised Code, to wit:       has a total of         hours of unexcused absences        in violation of Section 3321.38(A) of the Ohio Revised Code, an Unclassified Misdemeanor.
(Failure to Send Child to School - an Unclassified Misdemeanor)

Complainant further says:

That       now resides at      .
				
				_________________________________________                                      
				Sign name

				_________________________________________	
	                                                 	     	Print name (please print legibly or type)
					   (Complainant)
			 		
		  		 ________________________________________
			              	      (Complainant’s Address)

				Sworn to before me and signed in my presence, this
			___________day of__________________, 20     
                         			
			By_______________________________________	
		 			(Notary Public)