reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 16-A - Application for certified copy of adoption order (after sealing of records)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 114 Form 16-A
(Application for Certified
Copy of Adoption Order-
After sealing of records)
(9/2006)
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Adoption of (Docket)
						(File) No.
APPLICATION FOR
CERTIFIED COPY
OF ADOPTION
ORDER (After sealing
A Minor of the Age of years of
						records)
________
The undersigned applicant(s) respectfully
						show(s) that:
1. The applicants)
(and)
reside(s) at (and)
(respectively) in the County of, State
						of
2. On or about the day of,, an order was
						made by the Honorable, a judge of the Court of County, State of New York,
						approving the adoption of the above- named child by, and thereafter the order
						was duly filed in the office of the Clerk of the Court of the County of, and
						sealed.
3. It is necessary for the applicant(s) to
						obtain a certified copy of the order approving the adoption because of the
						following facts and circumstances [Explain. Note: if the applicant is a
						Native-American individual 18 years of age or older who is seeking information
						and/or records regarding the birth parents' tribal affiliation, so
						indicate]:
.
WHEREFORE, applicant(s) request(s) that
						the Court make an order directing the Clerk of the Court of the County of to
						prepare, certify
Adoption Form 16-A Page 2
and deliver to the applicant(s) a copy of
						the original order of adoption granted herein, and for such other and further
						relief as to the Court may be just and proper.
______________
Applicant
______________
Applicant
______________
Print or type name(s)
______________
Signature of Attorney, if any
______________
Attorney's Name (Print or Type)
________
________
______________
Attorney's Address and Telephone
						Number
VERIFICATION
STATE OF NEW YORK)
)ss.:
COUNTY OF)
, being duly sworn, say(s) that
						(he)(she)(they)(is)(are) the applicants) above named; that
						(he)(she)(they)(have)(has) read the foregoing application and the same is true
						to (his)(her)(their) knowledge except as to matters therein stated to be
						alleged on information and belief and as to those matters (he)(she)(they)
						believe(s) it to be true.
______________
Applicant
______________
Applicant
Subscribed and sworn to before me this day
						of,.
______________
(Deputy) Clerk of the Court
Notary Public
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 16-B - Order for certified copy of adoption order (after sealing of records)

Current through Register Vol. 46, No. 28, July
					 10, 2024
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New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 17 - Petition for enforcement of post-adoption contact agreement after adoption finalization (agency adoption)

Current through Register Vol. 46, No. 28, July
					 10, 2024
Image
Image
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 18 - Order determining petition for enforcement of post-adoption contact agreement after adoption finalization (agency adoption)

Current through Register Vol. 46, No. 28, July
					 10, 2024
Image
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New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 21-A - Petition for temporary guardianship

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 115-c; S.C.P.A. §
						1725
Form 21-A
(Temporary
Guardianship)
12/97
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Temporary
Guardianship of a Child Whose (Docket)
						(File) No.
First Name is
Petition for Temporary
Guardianship
________
The Petitioner(s) respectfully allege(s)
						to the Court that:
1. Physical custody of (first name) (last
						name)
, a child born on, was transferred to and,
						for the purposes of adoption on the day of, 19, by, the child's
						(parent(s))(guardian(s)), (and requirements for certification of as, qualified
						adoptive parents herein was duly waived by order of the Court, County of
						dated
2. The residence and telephone number of
						Petitioner(s) is
3. The full name(s) and address(es) of the
						natural parent(s) of the child are:
.
4. The anticipated name of the child
						subsequent to adoption will be
.
5. The anticipated residence of the child
						subsequent to adoption will be
.
Form 21-A page 2
6. A consent to the adoption of the child
						was duly executed pursuant to section
						115-b
						of the Domestic Relations Law on, 19 . A copy of the consent to the adoption is
						annexed hereto.
7. The child will be residing with
						Petitioner(s), and a petition for adoption of the child by Petitioner(s) will
						be filed in the Court of the County of, State of New York, within 45 days of
						the execution of the consent to adoption of the child.
8. No previous petition has been filed or
						application made to any court or judge for the relief sought herein (except)
						[include any proceedings dismissed or withdrawn]
WHEREFORE, Petitioner(s) pray(s) for an
						order granting temporary guardianship of the child to Petitioner(s).
______________
Petitioner(s)
________
______________
Applicant
______________
Print or type name
______________
Signature of Attorney, if any
______________
Attorney's Name (Print or Type)
________
________
______________
Attorney's Address and Telephone
						Number
Dated: 19
Form 21-A page 3
VERIFICATION
STATE OF NEW YORK)
) ss.:
COUNTY OF)
, being duly sworn, says that (he) (she)
						(they) (is)(are) the Petitioner(s) in the above-named proceeding and that the
						foregoing petition is true to (his) (her) (their) own knowledge, except as to
						matters therein stated to be alleged on information and belief, and as to those
						matters (he)(she)(they) believe(s) it to be true.
______________
Petitioner(s)
Subscribed and sworn to before me this day
						of, 19.
______________
(Deputy) Clerk of the Court
Notary Public
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 21-B - Order (temporary guardianship of the person)

Current through Register Vol. 46, No. 28, July
					 10, 2024
Image
Image
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 21-C - Notice (temporary guardianship)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 115-c Form 21-C
S.C.P.A. § 1725 (Temporary
Guardianship)
12/97
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Temporary
Guardianship of A Child Whose (Docket)
						(File) No.
First Name is NOTICE
________
TO:
PLEASE TAKE NOTICE that pursuant to
						section
						1725 of the Surrogate's Court Procedure Act
						and section
						661 of the
						Family Court Act:
1. A petition for adoption must be filed
						in this Court within 45 days from the date of the signing of the consent to the
						adoption which has been filed as part of the above-entitled proceeding.
2. Any order or decree of temporary
						guardianship entered in the above-entitled proceeding will expire no later than
						nine (9) months following its issuance or upon the entry of a final order of
						adoption, whichever is sooner, unless, upon application to the court, it is
						extended for good cause.
3. Any order or decree of temporary
						guardianship entered in the above-entitled proceeding will terminate upon
						withdrawal or denial of a petition to adopt the above-named child, unless the
						court orders a continuation of such order or decree.
Dated:, 19.
______________
Clerk of the Court
______________
Petitioner
______________
Print or type name
______________
Signature of Attorney, if any
______________
Attorney's Name (Print or Type)
________
________
______________
Attorney's Address and Telephone
						Number
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 21-D - Notice (denial or withdrawal of application; removal of child)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 115-C Form 21-D
S.C.P.A. § 1725 (Temporary
Guardianship)
12/97
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Temporary
						(Docket)(File) No.
Guardianship of A Child Whose
First Name is NOTICE
(Denial or Withdrawal of
Application; Removal of
Child)
________
TO:
PLEASE TAKE NOTICE that on the day of, 19
						:
() the petition of for an order of
						temporary guardianship was denied.
() the petition for adoption filed by has
						been
(he) (she) executed the same.
() the child,, has been removed from the
						physical custody of.
() the order dated the day of, 19,
						granting temporary guardianship of the child,, to has expired without the entry
						of a final order of adoption.
The law requires this notice to be sent to
						you. You may wish to consult a lawyer about your legal rights at this
						time.
Dated:, 19.
Form 21-D page 2
______________
CLERK OF THE COURT
______________
Petitioner
______________
Print or type name
______________
Signature of Attorney, if any
______________
Attorney's Name (Print or Type)
________
________
______________
Attorney's Address and Telephone
						Number
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 21-E - Affidavit (change of circumstances since certification as qualified adoptive parent)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 115-c Form 21-E
S.C.P.A. § 1725 (Temporary
Guardianship)
12/97
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Temporary
						(Docket)(File) No.
Guardianship of A Child Whose
First Name is AFFIDAVIT
(Change of circumstance since
						certification as qualified adoptive parent)
________
STATE OF NEW YORK)
) ss.:
COUNTY OF)
, being duly sworn depose(s) and
						say(s):
1. Deponent(s) (was)(were) certified as
						(a) qualified adoptive parent(s) by order of the
Court, County of, dated, 19 ;
2. The following change(s) in circumstance
						relevant and material to such certification (has)(have) taken place since that
						date:
Dated:
______________
Petitioner
______________
Print or type name
______________
Signature of Attorney, if any
______________
Attorney's Name (Print or Type)
________
________
______________
Attorney's Address and Telephone
						Number
Sworn to before me this day of,
						19.
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 23 - Affidavit and report (disinterested person certification proceeding) (private placement)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 115, 115-d Form
						23
(Certification as Qualified
Adoptive Parent)
9/99
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Adoption of
A Child Whose First Name Is (Docket)(File)
						No.
AFFIDAVIT and
REPORT (Disinterested
Person-Certification by Proceeding)
Adoptive Parent (Private-Placement)
________
State of New York)
: ss.
County of)
being duly sworn deposes and says
						that:
1. (He)(She) is a disinterested person as
						such person is defined in section
						115-d
						of the Domestic Relations Law in that:
and has no interest in the outcome of the
						application of the part(y)(ies) herein for certification as qualified adoptive
						parent(s);
2. The following fee(s) (have been) (will
						be) paid to deponent for services rendered in connection with the pre-placement
						investigation performed in connection with this certification
						proceeding:
;
3. The following is deponent's report of
						(his)(her) investigation into the truth and accuracy of the allegations set
						forth in the petition of, as qualified adoptive parents in the proceeding for
						certification and (deponent's investigation of the various factors relevant to
						the suitability of the petitioners as qualified adoptive parents:
Form 23 page 2
(a) Date, place and duration of personal
						interview and visit at petitioners home:
(b) Report:
(he) (she) executed the same.
Dated:
______________
Affiant (Disinterested Person)
______________
Print or type name
Sworn to before me this day of,.
______________
Notary Public
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 24 - Order certification as a qualified adoptive parent

Current through Register Vol. 46, No. 28, July
					 10, 2024
Image
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New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 25 - Conditional certification as a qualified adoptive parent

Current through Register Vol. 46, No. 28, July
					 10, 2024
Image
Image
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 26 - Petition for extension of expired certification

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 115, 115-d(9) Form
						26
(Certification Petition
For Extension of Expired
Certification - Private
Placement)
9/99
________
In the Matter of the Adoption of
A Child whose First Name is (Docket)
						(File) No.
PETITION
by Adoptive Parent(s) FOR EXTENSION
OF EXPIRED
CERTIFICATION
(Private Placement)
________
The Petitioner(s) respectfully allege(s)
						to this Court that:
1. (He)(She)(They) filed a petition to
						adopt the above-described child in this Court on,.
2. Petitioner(s) (was)(were) certified as
						a qualified adoptive parent(s), by order of the Court, County of, dated,, which
						order expired on,, within one year prior to the filing of the adoption
						petition.
3. The following change(s) in
						circumstances relevant and material to such certification (has)(have) taken
						place since issuance and expiration of the last certification:
4. Submitted herewith is written
						verification of any such change in circumstances or lack thereof by, a
						disinterested person as defined in section 115-d(4) of the Domestic Relation
						Law.
WHEREFORE, Petitioner(s) (prays) (prays)
						for an order extending the termination date of the earlier certification until
						eighteen months from the date of filing of the adoption petition, that
						is,
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive Parents: typed or printed
						name/signature
/
_________________________
Attorney: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
Form 26 page 2
VERIFICATION
STATE OF NEW YORK)
)ss.:
COUNTY)
being duly sworn, says that
						(he)(she)(they) (is)(are) the Petitioner(s) in the above- named proceeding and
						that the foregoing petition is true to (his)(her)(their) own knowledge, except
						as to matters therein stated to be alleged on information and belief and as to
						those matters (he)(she)(they) believes(s) it to be true.
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive Parent: typed or printed
						name/signature
Sworn to before me this day of,.
______________
(Deputy) Clerk of the Court
Notary Public
Resworn to before me this day of,.
______________
Judge of the Court
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 26-a - Affidavit and report (disinterested person-extension of expired certification)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 115, 115-d(9) Form
						26-a
(Certification as
Qualified Adoptive
Parent)
9/99
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Adoption of (Docket)
						(File) No.
A Child Whose First Name is
AFFIDAVIT and
REPORT
(Disinterested Person-
Extension of Expired by
Certification)
Adoptive Parent(s)
________
[Name], being duly sworn, deposes and says
						that:
1. I am a disinterested person as defined
						in section
						115-d
						(4) of the Domestic Relations Law in that
						(he)(she) has no interest in the outcome of the application of the part(y)(ies)
						herein for certification as (a) qualified adoptive parent(s).
2. The following fee(s) (have been) (will
						be) paid to deponent for services rendered in connection with the application
						for extension of certification:
3. I have read the affidavit and report
						prepared by and submitted in support of the petition for certification as (a)
						qualified adoptive parent(s) submitted by petitioner(s) on, . On information
						and belief, an order granting certification as a qualified adoptive parent(s)
						was made by the Court,
County, on,, and expired on,.
4. The following Change(s) in
						circumstances relevant and material to the extension of such certification
						(has)(have) taken place since the issuance and expiration of the last
						certification:
5. The source of my knowledge concerning
						the circumstances of the petitioner's(s') family and household is: [include
						date, place and duration of personal interview and visit at petitioner's(s')
						home.]
Form 26-a page 2
Dated:
______________
Affiant (Disinterested Person)
______________
Print or type name
Sworn to before me this day of,.
______________
Notary Public
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 27-B - Notice of petition for access to sealed adoption records

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 114 Adoption Form
						27-B
(Adoption-Notice of Petition for
Access to Sealed Adoption Records)
(9/2006)
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Adoption of (Docket)
						(File) No.
A Child Whose First Name is
NOTICE OF PETITION
FOR ACCESS TO SEALED
ADOPTION RECORDS
________
NOTICE IS HEREBY GIVEN THAT:
1. A petition has been filed in Family
						Court, County, requesting an order permitting access to sealed adoption records
						regarding the above-named child. This petition will be heard in the Family
						Court, County, located at [specify address and court part]: on [specify date
						and time]:
2. The Petitioner [specify name and
						address, unless confidential]:
is seeking access for medical
						reasons.
for good cause other than medical reasons
						in order to obtain information about tribal affiliation.
3. The following are the names and post
						office addresses of each person named or referred to in the petition as the
						living adoptive parents who have not already waived notice of this proceeding
						or consented to the relief requested in the petition, and each additional
						person to whom the Court may direct service of this Notice of Petition for
						Access to Sealed Adoption Records:
Name Mailing Address Relationship
Date:
______________
Name of Attorney, if any
________
______________
Attorney's Address and Telephone
						number
[Note: This Notice of Petition for Access
						to Sealed Adoption Records is served upon you as required by law. You are not
						required to appear or to respond. However, should you fail to appear or respond
						on or before the date set forth in Paragraph 1, it will be assumed you do not
						object to the relief requested. You may have an attorney appear for
						you.]
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 27-C - Affidavit of service of petition for access to sealed adoption records

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 114 Adoption Form
						27-C
[This form must be filed at least two days
						(Adoption- Affidavit of Service before the return date in Court. It must state
						of Petition for Access to Sealed the date, time and place of service] Adoption
						Records)
(9/2006)
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Adoption of
						(Docket)(File) No.
A Child Whose First Name is
AFFIDAVIT OF SERVICE
OF PETITION FOR
ACCESS TO SEALED
ADOPTION RECORDS
________
STATE OF)
COUNTY OF) SS:
I, [name]: of [state residence or business
						address]: having been duly sworn, deposes and states the following under
						penalties of perjury:
1. I am over the age of eighteen
						years.
2. I personally served the Notice of
						Petition for Access to Sealed Adoption Records on each person named below, each
						of whom I knew to be the person mentioned and described in the Notice, by
						delivering to and leaving with each of them personally a true copy of the
						Notice:
Name:
Date and Time served:
Place served:
Physical description of person served:
						Sex: Skin color: Hair color:
Approximate age: Weight: Height:
Name:
Date and Time served:
Place served:
Physical description of person served:
						Sex: Skin color: Hair color:
Approximate age: Weight: Height:
3. None of the persons named above is in
						the military service as defined by the Act of Congress known as the "Soldiers'
						and Sailors' Civil Relief Act of 1940" and the New York "Soldiers' and Sailors'
						Civil Relief Act."
Dated,.
______________
Affiant
______________
Print or Type Name
Sworn to before me this day of ,
______________
(Deputy) Clerk of the Court
Notary Public
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 27-D - Waiver of notice of petition for access to sealed adoption records

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 114 Adoption Form
						27-D
(Adoption--Waiver of Notice of
Petition for Access to
Sealed Adoption Records)
(9/2006)
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of the Adoption of (Docket)
						(File) No.
A Child Whose First Name is
WAIVER OF NOTICE OF PETITION
FOR ACCESS TO SEALED
ADOPTION RECORDS
________
1. I am the [check applicable box]:
						Adoptive Mother Adoptive Father Other [specify]: of the above-named child. I am
						18 years of age or older.
2. I am waiving the service of Notice of
						Petition for Access to Sealed Adoption Records in this matter and am consenting
						to the release of sealed adoption records to [specify]:
Dated: ________ ________
(Signature of Interested Party)
______________
(Print Name)
STATE OF ________)
COUNTY OF ________) SS:
On the ________ day of ________ in the
						year ________, before me, the undersigned, personally appeared ________,
						personally known to me or proved to me on the basis of satisfactory evidence to
						be the individual (s) whose name (s) is/are subscribed to the within instrument
						and acknowledged to me that he/she/they executed the same in his/her/their
						capacity (ies), and that by his/her/their signatures (s) on the instrument, the
						individual (s), or the person, upon behalf of which the individual (s) acted,
						executed the instrument.
______________
Notary Public
(Deputy) Clerk of Court
______________
Signature of Attorney, if any
______________
Attorney's Name (print or type)
________
______________
Attorney's Address and Telephone
						Number
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 27-E - Order on petition for access to sealed adoption records

Current through Register Vol. 46, No. 28, July
					 10, 2024
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New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter B - Adoption Forms Of The Family Court › Adoption Forms › Form 28-A - Order of foreign adoption and name change

Current through Register Vol. 46, No. 28, July
					 10, 2024
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New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VI - Forms For Use In Courts Exercising Criminal Jurisdiction › Form 5a - Nav. L. chemical tests-order

Current through Register Vol. 46, No. 28, July 10,
				2024
Sec. 49 Nav. L. Form 5A
(Nav. L. Chemical
Tests - Order)
9/89
________ Court of ________
County of ________
________ x
In the Matter of the Application of
________, Indictment/Docket
[name of applicant] No. ________
for an order to compel ORDER COMPELLING
SUBMISSION TO A
________to CHEMICAL TEST
[name of arrestee]
submit to a chemical test, pursuant to Nav. L.
				  § 49[FN1]
________ x
Upon the application [affidavit] of
				  ____________sworn to [dated] ________, 19 ________,
[name of applicant]
for an order pursuant to section
				  49 of the
				  Navigation Law to require ____________to submit
[name of arrestee]
to a chemical test, and sufficient reason
				  appearing therefor, it is
ORDERED that the arrestee submit to a chemical
				  test of the alcoholic or drug content of his/her blood, and it is
				  further
ORDERED that a person authorized pursuant to
				  section
				  49
				  (4)(e)(1) of the Navigation Law, em-
ployed at ____________ withdraw a proper
				  amount of blood from the arrestee, for the purpose of
[name of facility]
conducting such chemical test.
E N T E R
____________, New York
[location]
Date: ____________, 19 ________
Time: ____________ [a.m.] [p.m.]
______________
Judge [Justice]
______________
Applicant (if order issued orally)
[FN1] Strike all items not
				  applicable
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VI - Forms For Use In Courts Exercising Criminal Jurisdiction › Form Criminal Form 6 - Notice of conviction or youthful offender adjudication

Current through Register Vol. 46, No. 28, July 10,
				2024
Criminal Procedure Law §§ 380.90; 720.35(2),
				  720.35(3) [Applicable to Defendants Under the Age of 19 Who Are Criminal Form 6
				  Sentenced for Crimes or Adjudicated as Youthful Offenders 2/2001 and were
				  enrolled in school at the time of sentence]
_____ COURT OF THE STATE OF NEW YORK
COUNTY OF ______________
_________
People of the State of New York
Against
Indictment/Docket No.
Name:
Date of Birth:
Defendant NOTICE OF CONVICTION OR YOUTHFUL OFFENDER
				  ADJUDICATION ____________
TO: Designated Educational Official
[Specify
				  Name]:1________
School District and
				  School
[Specify, if available]: ________
PLEASE TAKE NOTICE that ______, the Defendant in the
				  above-entitled proceeding, was [check applicable box]:
convicted by this Court of the following crime(s) [specify]:
				  _________________________
adjudicated a Youthful Offender by this Court
and was sentenced as follows [specify]:
_______________________________________________________
on [specify date]:
_______________________________________________________
CLERK'S CERTIFICATION
I,
_______________________________________________________
, (Deputy) Clerk of the
_______________________________________________________
Court the State of New York,
County, do hereby certify that the above information is an
				  accurate summary of the records of this Court.
Date: ____
_______________________________________________________
_______________________________________________________
(Deputy) Clerk of the
Court
NOTICE
THIS NOTICE IS CONFIDENTIAL. IT MUST BE KEPT SEPARATE
				  AND APART FROM THE STUDENT'S SCHOOL RECORDS AND MUST NOT BE APPENDED TO OR
				  INCLUDED IN ANY DOCUMENTATION RELATING TO THE STUDENT. IT MUST BE DESTROYED
				  WHEN THE STUDENT IS NO LONGER ENROLLED IN THE SCHOOL DISTRICT. IT MAY BE
				  ACCESSIBLE ONLY TO THE EDUCATIONAL OFFICIAL DESIGNATED BY THE SCHOOL DISTRICT
				  PURSUANT TO CRIMINAL PROCEDURE LAW § 380.90(1) TO RECEIVE SUCH NOTICES AND
				  MAY BE USED SOLELY FOR THE PURPOSES SPECIFIED IN CRIMINAL PROCEDURE LAW
				  §§ 380.90 (2), 720.35(2), 720.35(3). IF THE STUDENT HAS BEEN
				  ADJUDICATED A YOUTHFUL OFFENDER PURSUANT TO ARTICLE 720 OF THE CRIMINAL
				  PROCEDURE LAW, THE DESIGNATED EDUCATIONAL OFFICIAL SHALL HAVE ACCESS SOLELY TO
				  THIS NOTICE AND SHALL NOT HAVE ACCESS TO ANY OTHER OFFICIAL RECORDS OR PAPERS
				  PERTAINING TO SUCH ADJUDICATION.
Footnotes
1 The Designated Educational Official for all public school
				  in New York City is Lillian Garelick, Director of Attendance Services, Division
				  of Student support Services, NYC Board of Education, 110 Livingston Street,
				  Room 506B, Brooklyn, NY 11201; Fax: 718-935-3356; e-mail:
				  lgareli@nycboe.net
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VI - Forms For Use In Courts Exercising Criminal Jurisdiction › Form 10 - Juror questionnaire

Current through Register Vol. 46, No. 28, July 10,
				2024
Sec. 270.15 C.P.L. FORM 10
(Juror Questionnaire)
10/85
JUROR QUESTIONNAIRE
YOU HAVE BEEN SELECTED TO SERVE AS A
				  PROSPECTIVE JUROR. THIS QUESTIONNAIRE IS DESIGNED TO ASSIST COUNSEL AND THE
				  COURT IN SELECTING FAIR AND IMPARTIAL JURORS. PLEASE ANSWER ALL OF THE
				  FOLLOWING QUESTIONS ON THE FORM: HOWEVER, IF THERE IS INFORMATION THAT YOU
				  WOULD PREFER TO KEEP CONFIDENTIAL, ASK TO SPEAK PRIVATELY TO THE JUDGE. THANK
				  YOU FOR YOUR COOPERATION.
1. Name____________
2. Sex____________
3. Place of birth____________
4. Current address____________
5. How long have you lived at your current
				  address?____________
How long have you lived in this
				  county?____________
6. Marital status____________
7. Years of education or highest degree
				  obtained____________
8. Occupation____________
9. Are you presently
				  employed?________________________
10. Spouse's occupation____________
11. Is your spouse presently
				  employed?____________
12. Number of ages of
				  children____________
13. Are any of your children presently
				  employed?____________
14. Occupations____________
15. Have you ever served on a state or federal
				  grand jury? ________ yes ________no
Have you ever served on a state or federal
				  trial jury? ________ yes ________no
If yes, state type of case (criminal or civil)
				  ____________
Did case reach a verdict? ________yes
				  ________no
Most recent date of jury
				  service________
16. Have you, any relative or close friend
				  ever been any of the following:
a. The victim of a crime ________yes
				  ________no
b. Witness to a crime ________yes
				  ________no
c. Accused of a crime ________yes
				  ________no
d. Convicted of a crime ________yes
				  ________no
e. Party to a civil case ________yes
				  ________no
17. Have you, any relative or close friend
				  ever been employed by any law enforcement agency or criminal justice
				  agency?
________yes ________no
18. Do you have any mental or physical
				  condition that would prevent you from serving as a juror?
________yes ________no
19. Do you have any difficulty reading,
				  understanding or speaking the English language? ____________
20. There is a possibility you may be required
				  to stay overnight in a hotel during deliberations. Is there any reason why you
				  feel you could not stay overnight if required and if you are given a day's
				  advance notice? ____________
If after completing this questionnaire you
				  feel you should not sit on this case for any other reason, please bring it to
				  the judge's attention when your name is called.
____________
AFFIRMATION
I AFFIRM THAT THE STATEMENTS MADE ON THIS
				  QUESTIONNAIRE ARE TRUE AND I UNDERSTAND THAT ANY FALSE STATEMENTS MADE ON THIS
				  QUESTIONNAIRE ARE PUNISHABLE UNDER ARTICLE 210 OF THE PENAL LAW.
______________
Signature of Prospective Juror
Dated: ________
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VI - Forms For Use In Courts Exercising Criminal Jurisdiction › Form 11 - Declaration of delinquency

Current through Register Vol. 46, No. 28, July 10,
				2024
Sec. 410.30 C.P.L. FORM 11
(Declaration of
Delinquency)
1/87
________ COURT OF ________
COUNTY OF ________
________ x
PEOPLE OF THE STATE OF NEW YORK,
- against - Indictment/Docket
No. ________
________ DECLARATION OF
DELINQUENCY
Defendant.
________ x
On ________, 19________, defendant was
				  sentenced to a period of (probation) (conditional discharge) [FN1].
The Court has reasonable cause to believe that
				  defendant violated a condition of (his)(her) sentence by [specify conditions
				  allegedly violated and give reasonable description of the time, place and
				  manner in which the violations allegedly occurred]:
____________
____________
____________
Wherefore, it is hereby:
ORDERED that defendant is declared delinquent,
				  and it is further
ORDERED that, to enable the Court to make a
				  final determination with respect to defendant's alleged delinquency:
(I) [FN3] ( ____________ and I jointly and
				  severally) undertake that defendant will appear in
() a warrant be issued, directing a peace
				  officer or appropriate police officer to take defendant into custody and bring
				  (him) (her) before the Court. [FN2]
E N T E R
Dated: ________, 19________
________, New York
______________
Judge (Justice)
[FN1] Strike words in parentheses, as
				  appropriate.
[FN2] The option of issuing a warrant should
				  be exercised only where reasonable and appropriate.
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VI - Forms For Use In Courts Exercising Criminal Jurisdiction › Form 12 - Order to appear at violation of probation hearing

Current through Register Vol. 46, No. 28, July 10,
				2024
Sec. 410.40 C.P.L. FORM 12
(Order to Appear at
Violation of
Probation Hearing)
1/87
NOTICE TO DEFENDANT
YOUR FAILURE TO APPEAR AT THE TIME AND PLACE
				  SPECIFIED BELOW WITHOUT REASONABLE CAUSE THEREFOR WILL CONSTITUTE A VIOLATION
				  OF THE CONDITIONS OF YOUR SENTENCE AND MAY RESULT IN THE ISSUANCE OF A WARRANT
				  FOR YOUR ARREST. YOU HAVE A RIGHT TO BE PRESENT AT ANY HEARING TO DETERMINE
				  WHETHER A VIOLATION OF PROBATION HAS OCCURRED. IF YOU INTENTIONALLY ABSENT
				  YOURSELF FROM THE COURT'S JURISDICTION OR INTENTIONALLY FAIL TO APPEAR AT A
				  VIOLATION OF PROBATION HEARING, A HEARING MAY BE HELD IN YOUR ABSENCE AND A
				  REVOCATION OF YOUR PROBATION MAY RESULT.
________ COURT OF ________
COUNTY OF ________
________ x
PEOPLE OF THE STATE OF NEW YORK,
- against - Indictment/Docket
No. ________
________, ORDER TO APPEAR AT
Defendant. VIOLATION OF PROBATION
HEARING
________ x
TO THE ABOVE-NAMED DEFENDANT:
PLEASE TAKE NOTICE that this Court, having
				  reasonable cause to believe that you violated a condition of the sentence
				  imposed on you on ________, 19________, and having filed a written Declaration
				  of Delinquency on ________, 19 ________, it is hereby
ORDERED that you appear before this Court in
				  (Part) (Room)[FN1]________, located at ________, on ________, 19________, at
				  9:30 a.m., for the purpose of enabling this Court to make a final determination
				  with respect to the alleged delinquency.
You are entitled to counsel at all stages of
				  any proceeding herein. You have the right to bring witnesses and present
				  evidence on your behalf and to cross-examine witnesses. You may request a
				  reasonable adjournment to prepare for your hearing.
E N T E R
Dated: ________, 19________
________, New York
______________
Judge (Justice)
[FN1] Strike words in parentheses, as
				  appropriate.
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VI - Forms For Use In Courts Exercising Criminal Jurisdiction › Form 13 - Judicial reprimand of probationer

Current through Register Vol. 46, No. 28, July 10,
				2024
Sec. 410.40 C.P.L. FORM 13
(Judicial Reprimand
of Probationer)
1/87
JUDICIAL REPRIMAND OF PROBATIONER
APPLICATION
STATE OF NEW YORK)
) ss.:
COUNTY OF ________)
________, being duly sworn, deposes and
				  says:
I am a probation officer with the ____________
				  Department of Probation. I am responsible for
[County]
supervising the probation of
				  ____________
[Name of Probationer]
who was convicted of (adjudicated a youthful
				  offender for the act of)
[Date of conviction],
on
______
[Name of Court] by the ________, and was
				  sentenced by
[Name of Judge/Justice]
to ________.
Based upon the following petitioner's failure
				  to ____________
____________
____________,
pursuant to C.P.L. §§410.20
______
[County] Department of Probation requests the
				  Court to
order probationer personally to appear before
				  the Court at the time and place set forth below.
______________
(Signature)
Sworn to before me this
________ day of ________, 19________.
______________
Notary Public
COURT ORDER
The above application by the ____________
				  Department of
[County]
Probation is granted. The probationer is
				  directed to appear before the Court on ________ at ________ (a.m.) (p.m.) in
				  Part ________ at ________. This order shall be (mailed to) (served personally
				  upon) the probationer.
______________
Judge (Justice)
- - - - - - - - - - - - - - - - - - - - - - -
				  - - - - - - - - - - - - -
NOTICE TO PROBATIONER
YOU HAVE BEEN ORDERED TO APPEAR BEFORE THE
				  COURT AT THE ABOVE TIME AND PLACE. FAILURE TO APPEAR AS ORDERED WITHOUT
				  REASONABLE CAUSE THEREFOR CONSTITUTES A VIOLATION OF THE CONDITIONS OF YOUR
				  SENTENCE OF PROBATION, AND MAY RESULT IN REVOCATION OF YOUR PROBATION AND
				  ISSUANCE OF A WARRANT DIRECTING THAT YOU BE TAKEN INTO CUSTODY AND BROUGHT
				  BEFORE THE COURT.
Date mailed () served upon ()
				  probationer:________, 19 ________
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VI - Forms For Use In Courts Exercising Criminal Jurisdiction › Form 14a - Enlargement of conditions of probation

Current through Register Vol. 46, No. 28, July 10,
				2024
Sec. 410.20, 410.40 C.P.L. FORM 14a
(Enlargement of
Conditions of Probation)
1/87
ENLARGEMENT OF CONDITIONS OF PROBATION
APPLICATION
STATE OF NEW YORK)
) ss.:
COUNTY OF ________)
________, being duly sworn, deposes and
				  says:
I am a probation officer with the ____________
				  Department of Probation. I am responsible for
[County]
supervising the probation of
				  ____________
[Name of Probationer]
who was convicted of (adjudicated a youthful
				  offender for the act of)
[Date of conviction],
on
______
[Name of Court] by the ________, and was
				  sentenced by
[Name of Judge/Justice]
to ________.
Based upon the following () new information ()
				  change in circumstances ________________________
____________,
pursuant to C.P.L. §§410.20 and
				  410.40, the
[County] Department of
Probation requests the Court to order
				  probationer personally to appear before the Court at the time and place set
				  forth below, so that the Court may entertain the Department's request that
				  probationer's conditions of probation be enlarged as follows
				  ____________
____________
____________
____________
______________
(Signature)
Sworn to before me this
________ day of ________, 19________.
______________
Notary Public
COURT ORDER
The above application by the ____________
				  Department of
[County]
Probation is granted. The probationer is
				  directed to appear before the Court on ________ at ________ (a.m.)(p.m.) in
				  Part ________ at ________. This order shall be (mailed to) (served personally
				  upon) the probationer.
______________
Judge (Justice)
- - - - - - - - - - - - - - - - - - - - - - -
				  - - - - - - - - - - - - - - -
NOTICE TO PROBATIONER
YOU HAVE BEEN ORDERED TO APPEAR BEFORE THE
				  COURT AT THE ABOVE TIME AND PLACE. FAILURE TO APPEAR AS ORDERED WITHOUT
				  REASONABLE CAUSE THEREFOR CONSTITUTES A VIOLATION OF THE CONDITIONS OF YOUR
				  SENTENCE OF PROBATION, AND MAY RESULT IN REVOCATION OF YOUR PROBATION AND
				  ISSUANCE OF A WARRANT DIRECTING THAT YOU BE TAKEN INTO CUSTODY AND BROUGHT
				  BEFORE THE COURT.
Date mailed () served upon () probationer:
				  ________, 19________
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VI - Forms For Use In Courts Exercising Criminal Jurisdiction › Form 14b - Order enlarging conditions of probation

Current through Register Vol. 46, No. 28, July 10,
				2024
Secs. 410.20, 410.40 C.P.L. FORM 14b
(Order Enlarging
Conditions of Probation)
1/87
At a Criminal Term, Part ________ of the
				  ________ Court of the State of New York, held in and for the County of
				  ________, on the ________ day of ________, 19________.
P R E S E N T:
Hon.
______
Judge (Justice)
X________X
IN THE MATTER
________, Indictment/Docket
No. ________
Probationer.
ORDER
X________X
The ____________ Department of Probation, by
				  Probation
[County]
officer ________, having applied for an order
				  pursuant to C.P.L. §410.20 to enlarge the conditions of the sentence of
				  probation, upon the ground that ____________
____________
____________
Now, upon reading and filing the application
				  of Probation Officer ________in support, and due deliberation having been had
				  thereon, and it appearing that ____________
____________
____________
it is
ORDERED, that effective as of this day, the
				  conditions of probation be modified as follows ____________
____________
____________
E N T E R
Dated: ________, 19________
________, New York
______________
Judge (Justice)
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VI - Forms For Use In Courts Exercising Criminal Jurisdiction › Form 15 - Elimination or relaxation of conditions of probation

Current through Register Vol. 46, No. 28, July 10,
				2024
Form 15
(Elimination or Relaxation of
Conditions of Probation)
1/87
ELIMINATION OR RELAXATION OF SPECIFIED
CONDITIONS OF PROBATION
APPLICATION
STATE OF NEW YORK)
) ss.:
COUNTY OF ________)
________, being duly sworn, deposes and
				  says:
I am a probation officer with the ____________
				  Department of Probation. I am responsible for
[County]
supervising the probation of
				  ____________
[Name of Probationer]
who was convicted of (adjudicated a youthful
				  offender for the act of)
[Date of conviction],
on
______
[Name of Court] by the ________, and was
				  sentenced by
[Name of Judge/Justice]
to ________.
Based upon the following () new information (
				  ) change in circumstances ____________
____________
____________
____________,
pursuant to C.P.L. §§410.20 and
				  410.40, the ____________ Department
[County]
of Probation respectfully requests that
				  probationer's conditions of probation be modified as follows
				  ____________
____________
____________
______________
(Signature)
Sworn to before me this
________ day of ________, 19________.
_________
Notary Public
- - - - - - - - - - - - - - - - - - - - - - -
				  - - - - - - - - - - - - - -
COURT ORDER
The above application by the ____________
				  Department
[County]
of Probation is granted to the extent that,
				  effective as of ________
19________, the conditions of probation are
				  modified as follows ____________
____________
____________
______________
Judge (Justice)
- - - - - - - - - - - - - - - - - - - - - - -
				  - - - - - - - - - - - - - -
NOTICE TO PROBATIONER
YOU HEREBY ARE NOTIFIED THAT YOUR CONDITIONS
				  OF PROBATION HAVE BEEN MODIFIED AS SET FORTH IN THE ABOVE ORDER, EFFECTIVE AS
				  OF THE DATE SPECIFIED IN SUCH ORDER. Notification mailed () served upon ()
				  probationer: ________, 19________