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~,3) Affiant further states that (s)he has consultedwith to consult withparents) o f said child in tha f o l l owi n g m a n n e r with the f o l l owi n g rftaulte;"

A) Affiant further siates that continuation o1 sad child \n his/her homa wou ld be contrary to the welfwe of saidchild; that It is insaid chUcks Bast interact that he/she be pla.;d out of his/her homo; and that theimmediate vesting of emergency temporary custody in RichUtnd County Children Services Board isnecessary to prevent Irreparable harm to sajd child for the flowingreasons:"" ~/"l t tr * ~Nt 1~TTA>CX!lAX-..'.'l }. ra fl.jg.oC - jr

For all the reasons stated abcva, gfiiant requasi that emergency temporary custody of said child be granted toRlchland County Children Services BoaJ.Further affiant saitn not , Caseworker, RCCSB

before me and signed in my preserica this r day of , 2 0

Notary My oommiesf

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ii. , .itfJ-' A *c *t m : ^ i w ' i - ^ 'IN THE COURT OF COMMON PLEAS OF IUCHLAND COUNTY. OHIOJUVENILE BRANCH

RON SPON. JUDEIN THE MATTER OF: C A S E NO.AFFIDAVITFOfl EM^RaENCY CUSTODY

1 ) .lQrvn-g- K l noJ *}Gp^~ ,. being f i r s t du ly s w a m , deposos ajid says t ha t (s)he isemployed by R i d h t a n d Oeunty Chi ld ren Services Boart i and, s u c h , as personal k n o w l e d g e r e g a r d i n g th eabova chi ld ; and that said 6hd is a ( n ) Q&pencJ t! __ __u n d r Section 2151 o f th s Oh i o Revised Coda fo r th e foUoHng re aso ns :

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A f f i a n t , further stdtds that: JS R C C S B h aa mjcc rcaaonabte efforts topcovant or t j l l i r i inatathe nd f o e r w n a v i lchild from W a l w ' h o m f t priof to placementaa ^j lb ive G fl " ' 'Q Reasonableefforts tu provant a r ^ I w k w t e thenwd tw penovalof takj-c'ilc romh g m p r i r s r to plocof iont wera n ot poeslhte because:

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IN THE COURT OF COMMON PLEAS OF HIGHLAND COUNTY, OHIOJUVENILE DIVISIONINTH E MATTER OF: ; CASE NO,

rC , r EX PARTE EMERGENCY ORDERTO TAKE CHILD INTO CUSTODYD O.S, 7-JO .ft- J- Q .a representative o1 h Richland County Children Services Board, ;o wfcby 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 by the Court, the Court finds that thera are raasonabb gto believe (I.e. "Probafala cause") that: ,

D The child is suffering from an llness or injury and Is not receiving proper car*,asdescribed in O.R.C. 21 51 .03, and removal is nac^esary to proven! immediate or threatenedv physical oremotions] harm. E 5 > The child is in immediate danger from his/her surroundings, aftd remova] h necessary toprevent imm ediate or threatened physical or emotional harm.G A parent, guardian, custodian, or other m ember of tho child's household has abused orneglected another child in the household, and this child la In danger of immediate or threatenephysical or emotional harm from that person,

Tho Court further finds that R ichlsnd County Children Services Boo.'d has made reasonable efforts to prevent or elimsaid child from his/her home prior to piacemanti1 that continuation or said child in Ws/her horns would c w contrary tobest Interest; and :t is ir > said chlld s best interests to be placed out of h!$rtir home; andReasonable efforts have been made to notify the parent(s), guardian, or oustodian of thischild regarding thchild's placement In shelter care and the reasons therefor.}3?*" Notification to the parent(s),guardianor custc

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/ U.IN THEC O U R T OFC O M M O N P LE A S OFRICHtANlP COl'NTY, OHIO-J V V E N X L K D IVIS IO N

In t h e M a t t e r O f:

DOB:.e;.._M.

F I L E D Cae No .R I C H l A H u C O M " Y , O H I OORDER^OR T E R M I N A T I O N OFZ O O I S tP -U EJ S f f i l f c Ht CY C U S T O D Y SHELTER C A R E(Sheltw C a r e H c i r i n g )

C i E R K O F JUVENILE C'JURlJ U D G E R O H S P O Htht m a t t e r t o t n w before K h e C o u r t u p o n review o f l h c Court's p r e v i o u j l y - g r a n tbu __ day of __ ,ex pr te emergency c u s to d y o r d e r , p u r s u a n t to 0, R , C . 2151J1(E), 2151,314, an d O h i o Jnv, Rules S(B) rt** SfJ* ,j Ii'g Kr>LA t/--fx^ CA, ry y. /l ji'- OT/

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dR ea jo o a b l e o r a l or w r i t t en n o t i c e vf thetfimt, place, aid p ur p o se of t l i is hiring h as been ([iva totbc c h i l d tod/or to h l s / b[is rentes),ie c h i l d ' s partm) r piarUion o r cuatodiaJi!!U tf1 " H , , not**

O A ll parties p r esen t wwr i n f o r m e d o f their r i g h t t o a n attoraey, A ad to a Cou r t - a ppo in t e d a t t o r n e y if indigentT h e C o u r t f i n d s , u p o n O the evidence presented Qtb v o l u n t a r y a. j rpcmcct or theparties 4 9 f o l l ow:

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Richland CountyChildren ServicesI Soholl , Onto *490V!571 Phonft ^1S) 774-4100 PAX 4tS) 774-4114 - y.-ww.rtehtjnocoUfllyc'lildrensojvlMS.org

BOAftt? MEMBERSCftalrNacy Joyed

Vleo O i a i rCarol PaytonSocrstary

Jon Bll

NOTIFICATION OF EMERGENCY REMOVAL OF CHILD(Rule 5101:2-30-12)_ a t %

Address 5?\8 Coul Tme:

Joe Palmar

Jan

From: Rfchland County Children ServicesRandy J.'Parker.Hxeuutlve Director731 Scholl RoadMansfield. Ohio 44907Phone: (419)774-4100

NOTICE: Y o u r enild(ren), bJlaQj k l_been temporarily taken into court-enteredcustody by the Rich'and County ChildrenC o u < x n j ,n'oy.'M,D, Sen/icesAgency for the fallowing reasons:Dean Wells

At 419-774-4100about this removaou areasked tocall - j .e^. At 419-774-4100about thfor aVisitation 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,411South Diamond $1,Mansfield, Ohio on:

DATE: -*! ATTIME: ( . C>OCOACWUi

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

Social Worker

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