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

COMPLAINT     
		Case No___________________	(please print legibly or type)

			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)