REPORT ON STATUS OF MINOR(S) AFTER ARREST/CUSTODY OF PARENT/GUARDIAN

GENERAL LAWS CHAPTER 6A, SECTION 18 3/4
 
Instructions: Pursuant to General Laws chapter 6A, section 18 3/4, this form is to be completed and submitted to the Executive Office of Public Safety & Security whenever a minor (a child under the age of 18) is left unsupervised because a parent or guardian has been arrested or taken into police custody.
Name of Police DepartmentPolice Department Incident Number
Date of IncidentTime of Incident
Arresting Police OfficerOfficer Completing Form
ID#: ID#:
Name: Name:
Parent/Guardian #1 Taken Into Custody:
Last NameFirst NameMiddle InitialD.O.B.
Parent/Guardian #2 Taken Into Custody:
Last NameFirst NameMiddle InitialD.O.B.
Minor #1
Last NameFirst NameMiddle InitialD.O.B.
Minor #2
Last NameFirst NameMiddle InitialD.O.B.
Minor #3
Last NameFirst NameMiddle InitialD.O.B.
Was a 51A report filed with the Dept. of Children & Families?

 
 

If yes, date filed:
If 51A Report not filed, please describe other action taken:

When you are finished filling out this form, press the Submit Report button below.