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

COMPLAINT     
	(CHILD OR CHILDREN)	Case No     
     
			FF #       

In the Matter of								Judge      

     
alleged unruly child.

The undersigned, after being duly sworn, according to law, says that he/she has knowledge of a certain child to wit:        age       years, D.O.B.       who appears to be an unruly child in that

During a period of time between      ,       in Lorain County, Ohio was an habitual truant, as defined in Section 2151.011(B)(18) of the Revised Code, to wit:      total unexcused hours of absences      , in violation of Section 2151.022(B) of the Ohio Revised Code.
(Habitual Truant)

Complainant further says:

That said child now resides at       .
That the names and the addresses of the parents or custodian of said child is       residing 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)