JV-117 (Rev. 03/12/2014)
PETITION FOR YOUNG ADULT
PERMANENCY HEARINGS
DOCKET NUMBER
Trial Court of Massachusetts
Juvenile Court Department
In the Matter of:
DIVISION
(Date) (Signature of Agency Representative)
Petition for Annual Permanency Hearings for Young Adult
Under the Responsibility of the Department of Children and Families
To the Justices of the Juvenile Court.
The Department of Children and Families represents:
1. The young adult, , born on , is over the
age of eighteen and currently resides in (type of placement) .
(Print Name)
(Address)
2. The young adult was placed in the care and/or custody of the Department of Children and Families (also
referred to as "Department") under one of the following court proceedings:
Care and Protection of Docket No.
Child Requiring Assistance (Child in Need of Services) Docket No.
3. The young adult and the Department of Children and Families entered into an agreement for the Department to
continue its responsibility to the young adult in accordance with G. L. c. 119, § 23(f). As a result of the agreement,
the young adult is under the responsibility of the Department.
4. Chapter 119, section 29B requires the court to hold annual permanency hearings for young adults who are
under the responsibility of the Department pursuant to G. L. c. 119, § 23(f).
WHEREFORE, the petitioner, the Department of Children and Families, respectfully requests this court to schedule
and hold annual permanency hearings for the above named young adult as required pursuant to G. L. c. 119,
§ 29B.
Telephone Number
