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Affiant further states that (s)he has consulted with

to consult with

parents) of said child in tha following manner with the following rftaulte;"

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Affiant further siates that continuation o1 said child \n his/her homa would be contrary to the welfwe of said child; that It is in said chUcks Bast interact that he/she be pla.;d out of his/her homo; and that the immediate vesting of emergency temporary custody in RichUtnd County Children Services Board is necessary to prevent Irreparable harm to sajd child for the flowing reasons:
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For all the reasons stated abcva, gfiiant requasi that emergency temporary custody of said child be granted to Rlchland County Children Services BoaJ. Further affiant saitn not , Caseworker, RCCSB

before me and signed in my preserica this r

day of

, 20

My oommiesf Notary

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IN THE MATTER OF:

IN THE COURT OF COMMON PLEAS OF IUCHLAND COUNTY. OHIO JUVENILE BRANCH RON SPON. JUDE

CASE NO.

AFFIDAVIT FOfl EM^RaENCY CUSTODY

1)

.lQrvn-g- Kl noJ *}Gp^~ ,. being first duly swam, deposos ajid says that (s)he is employed by Ridhtand Oeunty Children Services Boarti and, such, as personal knowledge regarding the abova child; and that said 6hd is a(n) Q&pencJ^t! __^__ undr Section 2151 of ths Ohio Revised Coda for the foUoHng reasons:
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Affiant, further stdtds that: JS " ' 'Q

RCCSB haa mjcc rcaaonabte efforts to pcovant or tjlliriinatathe nd foe rwnavil child from Walw'homft priof to placement aa ^jlbive Gfl Reasonable efforts tu provant ar ^Iwkwte the nwd tw penovalofftakj-c'ilcfrom hgm prirsr to plocofiont wera not poeslhte because:

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and Tornpiaioo\Emwgftn<!y Cu-st-xiy a. Paator Placement PackeWiCO'S Ufa Affidavit for Emergansy Cusiod>'.ao<i 5/1^2009

IN THE COURT OF COMMON PLEAS OF HIGHLAND COUNTY, OHIO JUVENILE DIVISION

IN THE MATTER OF: r C ,' r^

TO TAKE CHILD INTO CUSTODY D O.S, 7-'JO<&

; EX PARTE EMERGENCY ORDER

'Age:

CASE NO,

Pursuant to 0,R.C. 2151.31 and Ohio Juv. Rule 8 on (DateJ a representative o1 th Richland County Children Services Board, ;o wfc

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by telephone or otherwise, gave notice of intent to take tha above-named child Into custody and requested Court""" authorization 10 do so. Upon reliable information received bythe Court, the Court finds that thera are raasonabb grounds to believe (I.e. "Probafala cause") that: , D
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The child is suffering from an illness or injury and Is not receiving proper car*, as described in O.R.C. 21 51 .03, and removal is nac^esary to proven! immediate or threatened physical or emotions] harm. The child is in immediate danger from his/her surroundings, aftd remova] h necessary to prevent immediate or threatened physical or emotional harm. A parent, guardian, custodian, or other member of tho child's household has abused or neglected another child in the household, and this child la In danger of immediate or threatened physical or emotional harm from that person,

Tho Court further finds that Richlsnd County Children Services Boo.'d has made reasonable efforts to prevent or eliminate said child from his/her home prior to piacemanti1 that continuation or said child in Ws/her horns would cw contrary to his/her best Interest; and :t is ir> said chlld^s best interests to be placed out of h!$rtir home; and Reasonable efforts have been made to notify the parent(s), guardian, or oustodian of this child regarding th child's placement In shelter care and the reasons therefor. }3 ?*" Notification to the parent(s), guardian or custc<flan !s Inappropriate or otherwise unnecessary, as such notification would jaopcirdlza the physical or emotional safety of the child, or would result in the child being removed from the Court's jurisdiction. fontiA-ith be taken into custody and placed into the Gmarijency Shaitar Cere of the Rid'iiancf County Children Services Board. Further, a sworn complaint shall be file^i with respect to the cnikJ before the end of lha next business day after Hie day on which the child was taken into custody. In accordance with O. R .C, 2151 .31 (D) and (E), and Ohio Juv. Rule 6(B), Law enforcement ars hereby directed to assist Richtand Coj;^' Children Services in oWalning physical custody of the child, so as to prevent a breach of peace and to assure the safety of the child A hearing to determine whether "probable cause" exist for a continuation of this Order vyill be held at the Richlancs County Juvonite Court, 411 S. Diamond Sir.Mansfleld. Ohio 449O3 at

IT fS THEREFORE ORDERED, ADJUDGED, AND DECREED that the abov&-nami chiw

SO ORDERED, Data: *! /

R:\PU8UCAFomi8 find TennpIatasNNEW FORMATJ'ornis Oa^Csse ManagarrtisiiftRtejVemftrjjoncy Cvswtfy Piaeement PacKelSExParte Eiwgftne

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IN THE COURT OF COMMON PLEAS OF RICHtANlP COl'NTY, OHIO - JVVENXLK DIVISION In the Matter Of:

RICHlAHu COM" Y, OHIO

.
DOB:

FILED

Cae No.

ORDER^OR TERMINATION OF

ZOOI StP - U EJSffilfcHtCY CUSTODY SHELTER CARE

(Sheltw Care Hciring)

e;.._M.

Ci ERK OF JUVENILE C'JURl

Tbu __ ^ day of __ , tht matter totnw before Khe Court upon review oflhc Court's previoujly-grantcd ex prte emergency custody order, pursuant to 0, R,C. 2151J1(E), 2151,314, and Ohio Jnv, Rules S(B) rt*
* SfJ* ,j I i'g. K<w>r> L/ A t/--fx^ CA, try y.^/l^ji'..(re- 5 d Reajooable oral or written notice vf the tfimt, place, aid purpose of tliis hiring has been ([iva to tbc child tod/or to hls/ber [is rentes),
! ie child's partm<(>)r piarUion or cuatodiaJi! U/
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not

JUDGE ROHSPOH

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O All parties present wwr informed of their right to an attoraey, Aad to a Court-appointed attorney if indigent The Court finds, upon Thcro D is O the evidence presented GJboot Q tb voluntary a.jrpcmcct or the parties 49 follow:

"prp>>blc canst" for tbvbsiuncc of the u<o'rtAty Order

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D Continaed resideoca of the thild in the chU4'l correot home will t* cO.otrary to tbe child's boyt interest and welfare, *nd that it appears that th child'n eontuc<i pUcmcnt in Emergency $blter Cro Is requtrd under the provLsIon* pf O.K.C. 2151 Jl. D RCCBS has made rcatonabl* efforts to prevent the removal of the child from the child's home. HlRcanablc efforts were not ixmtblc due to r

The Court further finds that RicUIand County Children Services Board bay m>dc rcaioruible efforts to prevent or elitauut* (ho removal of said child from bun/her botno priorto placement; au<j it is to id ctiM's best iuterest to be placed oot of bi^Tjcr home; and furtbcr D A relative of the above-aamfrd ctOd It appropriate for appoiotiaent u t(imparry custodian. U No relative U "willing to be temporary costodiao of tbu child. Q A retativu of the above-named thitd i$ willing to be a temporary custodtaa Of tbo child, but would not be oppropriata tor the following rea*on(s):
'

IT IS THERfcFOftE QRPEREP, ADJUDGED AKP DECREED thati to- bl/ii*r pr""t( ...._ D^Ioced in the Emergency Shelter Care of die child'* reUtV __ ; __ O FjaewJ in tho EmcjTgejicy Shelter Care of tis Rkh(n<J County Choldreic Services Board. SO ORDERED.

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tefRCCSP Caieworker

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13 Father

D Other:

U.-UUV VORMS\CMELOHtf SERVICES TORM5\i.r?n Jailor <Mn-4oo

Richland County Children Services

I Soholl , Onto *490V! 571 Phonft ^1S) 774-4100 PAX (4tS) 774-41 14 - y.-ww.rtehtjnocoUfllyc'lildrensojvlMS.org

BOAftt? MEMBERS Cftalr Nacy Joyed

NOTIFICATION OF EMERGENCY REMOVAL OF CHILD (Rule 5101:2-30-12)

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Address 5?\8 Coul From: Time: Rfchland County Children Services Randy J.'Parker. Hxeuutlve Director 731 Scholl Road Mansfield. Ohio 44907 Phone: (419)774-4100

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Vleo Oiair
Carol Payton Socrstary Jon Bll

Joe Palmar
Jan

NOTICE:

Your enild(ren),

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l_

Cou<xn j

been temporarily taken into court-entered custody by the Rich'and County Children ,n'oy.'M,D, Sen/ices Agency for the fallowing reasons:

Dean Wells

At this You are asked to call - ^ j .e^. At 419-774-4100 about th removal for a Visitation Schedule and a Case Plan to be dev&foped with your assistance, There will be a court review of this matter at the Ffochland County Juvenile Court, 411 South Diamond $1, Mansfield, Ohio on: DATE:

COA

-*!
Social Worker

AT TIME: ( . C>O

You are expected to be present at this healing. You may call Amy Lee at the Juvenile Coul, (419-774-5557) to inquire about ihe appointment of an attorney if you cannot afford one.

CWUi

Date Original of this notification given fg DSfeDte/cgreqiver placed in fite: Parems unavailable, original of this notification left at parent-s address:
iflW O***'r 7^*7

"Safe CniJdren Today Build Strong Famines Tomorrow"

An A/ftrmative Action Equal OppoHttnffy Kmplo^f