reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's Court › Adoption Forms › Form 9-B - Affidavit of financial disclosure - parents (private-placement)

Current through Register Vol. 46, No. 28, July
					 10, 2024
S.S.L. § 374(6); Form 9-B
22 NYCRR 207.55(b)(8) (Affidavit of
						Financial
Disclosure - Parents -
Private-Placement)
12/97
SURROGATE'S 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
FINANCIAL
DISCLOSURE -
PARENTS
(Private Placement)
________
STATE OF NEW YORK)
ss:
COUNTY)
(and)
being duly sworn, depose(s) and
						say(s):
1. That deponent(s) reside(s) at
and (is)(are)
the (petitioning adoptive parent(s) (birth
						or legal parent(s)) of the above-named adoptive child; and
2. That deponent(s) (has)(have) paid or
						given or caused to be paid or given or undertaken to pay or give the following
						expenses, contributions, compensation or things of value, either directly or
						indirectly, to any person, agency, association, corporation, institution,
						society or organization, in connection with the placing out of said adoptive
						child with deponent(s) or with the adoption of said child by
						deponent(s):
[Specify recipient, amount, form, and
						purpose of each payment. If none, so state.]
;
3. That deponent(s) (has)(have) requested,
						received or accepted either directly or indirectly, the following compensation
						or things of value from any person, agency, association, corporation,
						institution, society or other organization in connection with the placing out
						of said adoptive child with deponent(s) or with the adoption of said child by
						deponent(s).
Form 9-B page 2
[Specify source, amount, form
and purpose of each payment
requested or received. If none,
so state.]
/
[FN ]
_________________________
*(Adoptive)(Birth)(Legal) Parent: typed or
						printed name/signature
/
_________________________
*(Adoptive)(Birth)(Legal) Parent: typed or
						printed name/signature
/
_________________________
Adoptive child if over 18: typed or
						printed name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
Sworn to before me this day of, 19.
______________
Judge of the Court
[FN ] Delete inapplicable
						provisions.
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's Court › Adoption Forms › Form 10-A - Supplemental affidavit (agency)

Current through Register Vol. 46, No. 28, July
					 10, 2024
22 NYCRR 207.55(c) Form 10-A
(Supplemental Affidavit
Agency)
12/97
SURROGATE'S 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
SUPPLEMENTAL
AFFIDAVIT
(AGENCY)
________
STATE OF NEW YORK)
ss:
COUNTY OF)
(and)
being duly sworn, depose(s) and
						say(s):
That deponent(s) (is) (are) the same
						person(s) who on
filed in this Court a petition for
						adoption of the above-named adoptive child. Deponent(s) reallege(s) and
						reaffirm(s) each of the matters set forth in said petition heretofore filed and
						represent(s) to the Judge of this Court that there has been no change of
						circumstances whatsoever since the filing of said original petition, dated:
						except as follows:
Date:
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive child if over 18: typed or
						printed name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
Sworn to before me this day of, 19.
______________
Judge of the Court
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's Court › Adoption Forms › Form 10-B - Supplemental affidavit (private-placement)

Current through Register Vol. 46, No. 28, July
					 10, 2024
22 NYCRR 207.55(c) Form 10-B
(Supplemental Affidavit-
Private-Placement)
12/97
SURROGATE'S 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
SUPPLEMENTAL
AFFIDAVIT
(Private-Placement)
________
STATE OF NEW YORK)
ss:
COUNTY OF)
(and)
being duly sworn, depose(s) and
						say(s):
1. Deponent(s) (is) (are) the same
						person(s) who on
filed in this Court a petition for
						adoption of the above-named adoptive child.
2. Deponent(s) (is)(are) over the age of
						twenty-one years, citizen(s) of the United States, and (unmarried)(married and
						living together) (married and living apart).
3. The post-office addresses, place(s) of
						residence and home telephone number(s) of petitioner(s) (is)(are)
Petitioner (specify name):
Petitioner (specify name):
4. Petitioner(s) hereby state(s) that
						there has been no change of circumstances whatsoever since the filing of said
						original petition, dated, except as follows:
Form 10-B page 2
Date:
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive Parent: typed or printed
						name/signature
/
_________________________
Adoptive child if over 18: typed or
						printed name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
Sworn to before me this day of, 19.
______________
Judge of the Court
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's Court › Adoption Forms › Form 11 - Order to show cause (removal of child from adoptive home)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 116(2) Form 11
(Order to Show Cause
Removal of Child from
Adoptive Home
12/97
At a term of the Surrogate's Court of
						the
State of New York, held in and for
						the
County of ,
at, New York,
on.
P R E S E N T
Hon.
Judge
________
In the Matter of the Adoption of
						(Docket)(File) No.
A Child Whose First Name Is
ORDER TO SHOW
CAUSE (Removal
of Child from
Adoptive Home)
________
UPON reading and filing the report dated,
						19 of, the investigator designated by an order of this Court to examine into
						the allegations set forth in the petition herein; it is
ORDERED THAT
, the petitioner(s) herein show cause
						before this Court at, New York, on the day of, 19 at o'clock in the noon of
						that day or as soon thereafter as counsel can be heard why an order should not
						be granted removing ,
the above-named adoptive child, from the
						home of
(iv), CPLR 315 (Order of
						Publication
Form 11 page 2
ORDERED that service of a copy of this
						order (and the report upon which it was granted) upon the persons above-named
						(and upon
and), personally within the State of New
						York on or before the day of, 19, be deemed sufficient service.
Dated, 19.
ENTER
______________
(SURROGATE)
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's Court › Adoption Forms › Form 12 - Order removing child from adoptive home

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 116(2) Form 12
(Order Removing Child From
Adoptive Home)
12/97
At a term of the Surrogate's Court of
						the
State of New York, held in and for
						the
County of ,
at New York
on, 19.
PRESENT:
Hon.
Judge
________
In the Matter of the Adoption of (Docket)
						(File) No.
A Child Whose First Name Is
ORDER REMOVING
CHILD FROM
ADOPTIVE HOME
________
, the adoptive child above named having
						been
placed for adoption on or about, 19, with
						the petitioner(s) herein, and a petition having been duly filed in this Court
						praying for an order of adoption pursuant to section
						116 of
						the Domestic Relations Law; and
This Court having on the day of, 19,
						issued an order of investigation designating
to examine into the allegations set forth
						in the petition and to make a written report of the investigation; and the
						investigator having duly made and submitted a written report of investigation
						dated, 19 ; and it appearing from the report that good cause exists for the
						removal of the adoptive child from the home of said petitioner(s); and
The petitioner(s) having been ordered to
						show cause why the adoptive child should not be removed from the home of said
						petitioner(s); and due notice of this proceeding having been given to
						(and
);
and the Court having taken proof of the
						facts shown by the investigations and the Court being satisfied that the
						welfare of the adoptive child requires that (he) (she) be removed from the home
						of the petitioner(s);
Form 12 page 2
Now, therefore, it is hereby
ORDERED that, the adoptive child, be and
						(he) (she) hereby is removed from the home of (and) and is (transferred to the
						Family Court) (returned to) (placed with [specify]:
); (and it is further)
(ORDERED that a copy of this order be
						served upon
, an authorized agency.)
ENTER
______________
(SURROGATE)
Dated: 19.
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's Court › Adoption Forms › Form 14 - Certificate of adoption

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 114 Form 14
(Certificate of Adoption)
12/97
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF
CERTIFICATE OF ADOPTION
I,, Clerk of the
Court of County, do hereby certify that I
						have inspected the records of this Court and find that:
AN ORDER OF ADOPTION was signed on the day
						of, 19, by Honorable, Judge of the Court of the County of, granting the
						petition of (and), adoptive parent(s) of a child now known and called by the
						name of, who was born at, on the day of, 19.
This certificate as to the facts recited
						herein shall have the same force and effect as a certified copy of an order of
						adoption.
IN TESTIMONY WHEREOF, I have hereunto set
						my hand and affixed the seal of the
Court of the County of
this day of, 19.
______________
Clerk of the Court
of the County of
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's Court › Adoption Forms › Form 15-A - Application for certified copy of adoption order (before sealing of records)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 114 Form 15-A
(Application for
Certified Copy of
Adoption Order Before
sealing of records)
12/97
SURROGATE'S 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
(Before sealing of
records)
A Minor of the Age of years
________
The undersigned applicant(s) respectfully
						show(s) that:
1. The applicant(s) (and)
reside(s) at (and) (respectively) in
						the
County of, State of.
2. On or about the day of, 19, an order
						was made by the Honorable Judge of the Court of County, State of New York,
						approving the adoption of the above-named child by
, and thereafter, said order was duly
						filed in the office of the Clerk of the
Court of the County of.
3. It is necessary for the applicant(s) to
						obtain a certified copy of said order approving the adoption because of the
						following facts and circumstances:
WHEREFORE, applicant(s) pray(s) that the
						Court make an order directing the Clerk of the
Court of the County of to prepare, certify
						and deliver to the applicant 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
Form 15-A page 2
______________
Petitioner
______________
Print or type name
______________
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 applicant(s) 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, 19.
______________
(Deputy) Clerk of the Court
Notary Public
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's Court › Adoption Forms › Form 15-B - Order for certified copy of adoption order (before sealing of records)

Current through Register Vol. 46,
					 No. 28, July 10, 2024
D.R.L. § 114 Form 15-B
(Order for Certified Copy
of Adoption Order-Before
sealing of records)
12/97
At a term of the Surrogate's Court of
						the
State of New York, held in and for
						the
County of ,
at, New York
on.
PRESENT:
Hon.
Judge
________
In the matter of the Adoption of
						(Docket)(File) No.
ORDER FOR
CERTIFIED COPY OF
ADOPTION ORDER
A Minor of the Age of years (Before
						sealing of
records)
________
UPON reading and filing the application of
						and
duly verified the day of, 19, requesting
						this Court to issue an order authorizing the Clerk of the Court of the County
						of to prepare, certify and deliver to said applicant(s) a copy of the original
						order of adoption granted herein; and the Court being satisfied that there is
						good and proper cause for granting such request; and upon all of the
						proceedings had herein; it is
ORDERED that the Clerk of the Court of the
						County of
be and (s)he hereby is authorized to
						prepare, certify and deliver to said applicant(s) a copy of the original order
						of adoption granted herein.,
ENTER
______________
(Surrogate)
Dated:, 19.
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's 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
Sec. 114 D.R.L. Form 16-A
(Application for Certified
Copy of Adoption Order-
After sealing of records)
12/97
SURROGATE'S 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 applicant(s)
(and)
reside(s) at (and)
(respectively) in the County of, State
						of
2. On or about the day of, 19, 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 said 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 said order approving the adoption because of the
						following facts and circumstances:
.
WHEREFORE, applicant(s) pray(s) that the
						Court make an order directing the Clerk of the Court of the County of to
						prepare, certify 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.
Adoption Form 16-A page 2
______________
Applicant
______________
Applicant
______________
Petitioner
______________
Print or type name
______________
Signature of Attorney, if any
______________
Attorney's Name (Print or Type)
________
________
______________
Attorney's Address and Telephone
						Number
Adoption Form 16-A page 3
VERIFICATION
STATE OF NEW YORK)
)ss.:
COUNTY OF)
, being duly sworn, say(s) that (he) (she)
						(they) (is) (are) the applicant(s) 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, 19.
______________
(Deputy) Clerk of the Court
Notary Public
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's 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
D.R.L. § 114 Form 16-B
(Order for Certified
Copy of Adoption
Order - After sealing
of records)
12/97
At a term of the Surrogate's Court of
						the
State of New York, held in and for
						the
County of ,
at, New York
on, 19
PRESENT
Hon.
Judge
________
In the matter of the Adoption of
						(Docket)(File) No.
ORDER FOR
A Minor of the Age of years CERTIFIED COPY
						OF
ADOPTION ORDER
(After sealing of records)
________
UPON reading and filing the application of
						and
duly verified the day of, 19, requesting
						this Court to issue an order authorizing the Clerk of the Court of the County
						of to prepare, certify and deliver to said applicant(s) a copy of the original
						order of adoption granted herein; and the Court being satisfied that there is
						good and proper cause for granting such request; and upon all of the
						proceedings had herein; it is
ORDERED that the Clerk of the Court of the
						County of be and (s)he hereby is authorized to prepare, certify and deliver to
						said applicant(s) a copy of the original order of adoption granted
						herein.
ENTER
______________
Surrogate
Dated:
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's 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
SURROGATE'S 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 VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's Court › Adoption Forms › Form 21-B - Order (temporary guardianship of the person)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. § 115-c Form 21-B
S.C.P.A. § 1725 (Temporary
Guardianship)
12/97
At a term of the Surrogate's Court of
						the
State of New York, held in and for
						the
County of ,
at New York
on, 19.
PRESENT:
Hon.
Judge
________
In the Matter of the Temporary (Docket)
						(File) No.
Guardianship of A Child Whose
First Name is ORDER
(Temporary
Guardianship
of the Person)
________
Upon reading and filing the petition
						herein duly verified on applying for (temporary guardianship of, a child placed
						for adoption,) (an order approving the adoption of, an adoptive child) and it
						appearing that the child will be residing with the Petitioner(s) and that
						Petitioner(s) intend to file for adoption of the child within 45 days of the
						execution of the consent to the adoption of the child, and the Court having
						inquired of the statewide central register of child abuse and maltreatment and
						having been informed that the (child) (Petitioner(s)) (is)(are)(not) a subject
						of or another person named in an indicated report filed with such register as
						such terms are defined in section
						412 of the
						Social Services Law, and the Court having given due consideration to any
						information contained therein,
And it appearing further it is (not) in
						the best interests of the child to grant said petition
NOW therefore, it is hereby
Form 21-B page 2
(ORDERED that said application for
						temporary guardianship is granted; and it is further
ORDERED that be appointed temporary
						guardian(s) of the person
of : and it is further
ORDERED that this order shall expire on or
						the date a final order of adoption is entered, whichever is sooner.)
(ORDERED, that said application for
						temporary guardianship is denied;) (and it is further)
(ORDERED that the proceeding herein be
						continued for further investigation;) (and it is further)
(ORDERED that upon notice to, the
						Petitioner(s)
shall appear on the day of, 19, at to show
						cause why the child should not be removed from their home;)
ENTER
______________
(Surrogate)
Dated:, 19.
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's Court › Adoption Forms › Form 21-C - Notice

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
SURROGATE'S 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 VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's 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. § 1115-C Form 21-D
S.C.P.A. § 1725 (Temporary
Guardianship)
12/97
SURROGATE'S 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
(iv), CPLR 315 (Order of
						Publication
() 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.
______________
CLERK OF THE COURT
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's 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
SURROGATE'S 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 VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's 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)
12/97
SURROGATE'S 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:
(iv), CPLR 315 (Order of
						Publication
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 VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's Court › Adoption Forms › Form 24 - Order (certification as a qualified adoptive parent)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 115, 115-d Form
						24
(Certification as
Qualified Adoptive
Parent)
12/97
At a term of the Surrogate's Court of
						the
State of New York, held in and for
						the
County of ,
at New York
on, 19.
PRESENT:
Hon.
Judge
________
In the Matter of the Adoption of
						(Docket)(File) No.
A Child Whose First Name is
ORDER
(Certification as a
Qualified Adoptive
by Parent)
Adoptive Parent
________
NOTICE: THIS ORDER IS VALID ONLY
						UNTIL
The petition of, verified the day of, 19,
						and filed in this court on the day of, 19, applying for certification as (a)
						qualified parent(s) of the adoptive child above-named and a report having been
						filed herein by, a disinterested person as defined in section
						115-d
						of the Domestic Relations Law
Now therefore upon consideration of said
						report and all other relevant and material factors, it is hereby
(ORDERED that are certified as (a)
						qualified adoptive parent(s) of the above-named adoptive child and may accept
						physical custody of a child for the purposes of adoption prior to or
						contemporaneous with the filing of an adoption petition.)
(ORDERED that the application by for
						certification as (a) qualified adoptive parent(s) is hereby denied for the
						following reasons:
.)
ENTER
______________
Surrogate
Dated:, 19.
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's Court › Adoption Forms › Form 25 - Order (conditional certification as a qualified adoptive parent)

Current through Register Vol. 46, No. 28, July
					 10, 2024
D.R.L. §§ 115, 115-d Form
						25
(Certification
as Qualified
Adoptive Parent)
12/97
At a term of the Surrogate's Court of
						the
State of New York, held in and for
						the
County of ,
at, New York
on
PRESENT:
Hon.
Judge
________
In the Matter of the Adoption of
A Child Whose First Name is (Docket)
						(File) No.
ORDER
(Conditional Certification
as a Qualified Adoptive
Parent)
by
Adoptive Parent(s)
________
The petition of verified the day of
						,
19, having been filed in this court on the
						day of, 19, applying for certification as (a) qualified parent(s) of the
						adoptive child above-named; and
The petition indicating no prior criminal
						convictions, pending child protective investigations, or founded findings of
						child abuse or neglect; and
A report having been filed herein by a
						disinterested person as defined in section
						115-d
						of the Domestic Relations Law; and
Pending completion of any further reports,
						investigations or inquiries ordered by the Court or required by any other
						statute or Court rule;
Now, therefore, upon consideration of said
						report and all other relevant and material factors, it is hereby
Form 25 page 2
ORDERED that (is) (are)
conditionally certified as (a) qualified
						adoptive parent(s) of the above-named adoptive child and may accept physical
						custody of such child for the purposes of adoption prior to or contemporaneous
						with the filing of an adoption petition.
NOTICE: THIS ORDER OF CONDITIONAL
						CERTIFICATION IS VALID UNTIL REPLACED BY AN ORDER OF CERTIFICATION OR BY AN
						ORDER DENYING CERTIFICATION, BUT IN NO EVENT BEYOND 180 DAYS OF THIS
						DATE.
ENTER
______________
Surrogate
Dated:, 19.
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's 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)
12/97
SURROGATE'S 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.
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, 19.
2. Petitioner(s) (was)(were) certified as
						a qualified adoptive parent(s), by order of the Court, County of, dated, 19,
						which order expired on, 19, 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
						11-d
						(4) of the Domestic Relations Law.
WHEREFORE, petitioner(s) (pray) (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 child if over 18: typed or
						printed name/signature
/
_________________________
Attorney if any: typed or printed
						name/signature
_________________________
Attorney's Address and Telephone
						number
Form 26 page 2
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 wherein 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, 19.
______________
(Deputy) Clerk of the Court
Notary Public
Resworn to before me this day of,
						19.
______________
Judge of the Court
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter B - Adoption Forms Of The Surrogate's 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)
12/97
SURROGATE'S 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, 19 . On information and belief, an order granting
						certification as a qualified adoptive parent(s) was made by the Court,
County, on, 19, and expired on, 19.
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:
______________
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.
______________
Notary Public
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VIII - Forms Required By Section 527 Of Judiciary Law And Section 128.12 Of Nycrr Relating To The Jury System (cf.section 128.12) › Notices of Noncompliance › Form UCS-134 - Failure to respond to juror qualification questionnaire

Current through Register Vol. 46, No. 28, July
				  10, 2024
NOTICE OF NONCOMPLIANCE
FAILURE TO RESPOND TO
JUROR QUALIFICATION QUESTIONNAIRE
TO: ____________
____________
____________
PLEASE TAKE NOTICE that, pursuant to section
					 527 of the
					 Judiciary Law, you are charged with failure to complete and return to the
					 Commissioner of Jurors a juror qualification questionnaire that was mailed to
					 you and that should have been returned by ________, 19 ________.
You are hereby required to respond to the
					 above charge within 20 days from the date of this notice by checking the
					 appropriate box at the bottom of this form, signing your name, and returning
					 this form to:
____________
____________
____________
____________
Your response will be submitted to the
					 Supreme Court, ________ County. If you admit the conduct charged, or if the
					 charges are sustained after a hearing, you will be ordered to perform jury
					 service at a future date certain, and the Court also may impose against you a
					 financial penalty, not to exceed $250. If you request a hearing, you will be
					 advised by the Court of a hearing date at which you will be required to appear
					 in court. You may be represented by an attorney at this hearing.
Failure to respond to this notice shall be
					 deemed an admission of the conduct charged, and a default judgment may be
					 entered against you in the Supreme Court for a penalty in an amount up to $250,
					 together with an order directing that you perform jury service at a future date
					 certain.
Dated: ________
______________
Commissioner of Jurors
............
(DO NOT DETACH)
Response to Charges
[ ] I admit the conduct charged in this
					 notice.
[ ] I request a hearing before a judge or
					 judicial hearing officer.
______________
(Signature)
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VIII - Forms Required By Section 527 Of Judiciary Law And Section 128.12 Of Nycrr Relating To The Jury System (cf.section 128.12) › Notices of Noncompliance › Form UCS-135 - Failure to respond to a subpoena to appear for purposes of juror qualification

Current through Register Vol. 46, No. 28, July
				  10, 2024
NOTICE OF NONCOMPLIANCE
FAILURE TO RESPOND TO
A SUBPOENA TO APPEAR FOR
PURPOSES OF JUROR QUALIFICATION
TO: ____________
____________
____________
PLEASE TAKE NOTICE that, pursuant to section
					 527 of the
					 Judiciary Law, you are charged with failure to appear for purposes ofjuror
					 qualification pursuant to a subpoena that was mailed to you that required your
					 appearance on ________, 19 ________, for the purposes of juror
					 qualification.
You are hereby required to respond to the
					 above charge within 20 days from the date of this notice by checking the
					 appropriate box at the bottom of this form, signing your name, and returning
					 this form to:
____________
____________
____________
____________
Your response will be submitted to the
					 Supreme Court, ________ County. If you admit the conduct charged, or if the
					 charges are sustained after a hearing, you will be ordered to perform jury
					 service at a future date certain, and the Court also may impose against you a
					 financial penalty, not to exceed $250. If you request a hearing, you will be
					 advised by the Court of a hearing date at which you will be required to appear
					 in court. You may be represented by an attorney at this hearing.
Failure to respond to this notice shall be
					 deemed an admission of the conduct charged, and a default judgment may be
					 entered against you in the Supreme Court for a penalty in an amount up to $250,
					 together with an order directing that you perform jury service at a future date
					 certain.
Dated: ________
______________
Commissioner of Jurors
............
(DO NOT DETACH)
Response to Charges
[ ] I admit the conduct charged in this
					 notice.
[ ] I request a hearing before a judge or
					 judicial hearing officer.
______________
(Signature)
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VIII - Forms Required By Section 527 Of Judiciary Law And Section 128.12 Of Nycrr Relating To The Jury System (cf.section 128.12) › Notices of Noncompliance › Form UCS-136 - Failure to respond to summons for jury service

Current through Register Vol. 46, No. 28, July
				  10, 2024
NOTICE OF NONCOMPLIANCE
FAILURE TO RESPOND TO
SUMMONS FOR JURY SERVICE
TO: ____________
____________
____________
PLEASE TAKE NOTICE that, pursuant to section
					 527 of the
					 Judiciary Law, you are charged with failure to respond to a summons for jury
					 service to begin on ________, 19________.
You are hereby required to respond to the
					 above charge within 20 days of the date of this notice by checking the
					 appropriate box at the bottom of this form, signing your name, and returning
					 this form to:
____________
____________
____________
____________
Your response will be submitted to the
					 Supreme Court, ________ County. If you admit the conduct charged, or if the
					 charges are sustained after a hearing, you will be ordered to perform jury
					 service at a future date certain, and the Court also may impose against you a
					 financial penalty, not to exceed $250. If you request a hearing, you will be
					 advised by the Court of a hearing date at which you will be required to appear
					 in court. You may be represented by an attorney at this hearing.
Failure to respond to this notice shall be
					 deemed an admission of the conduct charged, and a default judgment may be
					 entered against you by the Supreme Court for a penalty in an amount up to $250,
					 together with an order directing that you perform jury service at a future date
					 certain.
Dated: ________
______________
Commissioner of Jurors
............
(DO NOT DETACH)
Response to Charges
[ ] I admit the conduct charged in this
					 notice.
[ ] I request a hearing before a judge or
					 judicial hearing officer.
______________
(Signature)
New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IX - Forms For Commercial Claims Parts Of Court › Form UCS-119 - Application to file claim

Current through Register Vol. 46, No. 28, July 10,
				2024
UCS-119 (Rev. 11/90)
State of New York FOR CLERK'S USE ONLY
________ Court of ________ Notice was mailed
				  on
____________ day of ____________,
				  19________,
to ____________
(Address of Defendant)
Date of delivery ____________
Home address of person who signed receipt
				  ____________
(from the receipt form)
Application: Small Claim ________
Commercial Claim ________
Commercial Claim ________
(Consumer Transaction)
Filing Fee:
Small Claim - $ 3.00 + postage
Commercial Claim - $20.00 + postage
Dated ________
Name of Claimant ________
Address (if commercial claim, give Principal
				  Office Address)
____________
Telephone ________
-against-
Name if Defendant ________
Address (Home or Bus./Place of Employment)
				  ____________
____________
............ COMPLETE THIS SECTION FOR
				  COMMERCIAL CLAIM ............
[FN1]CERTIFICATION: (NYCCA 1803-A; UCCA
				  1803-A; UDCA 1803-A)
I hereby certify that no more than five (5)
				  actions or proceedings (including the instant action or proceeding) pursuant to
				  the commercial claims procedure have been initiated in the courts of this State
				  during the present calendar month.
______________
Signature of Claimant
______________
Signature of Notary/Clerk/Judge
UCS-119 (Rev. 11/90)
............ COMPLETE THIS SECTION FOR
				  COMMERCIAL CLAIM ............
ARISING OUT OF A CONSUMER TRANSACTION
[FN1]Certification: (NYCCA 1803-A; UCCA
				  1803-A; UDCA 1803-A)
I hereby certify that I have mailed a demand
				  letter by ordinary first class mail to the party complained against, no less
				  than ten (10) days and no more than one hundred eighty (180) days before I
				  commenced this claim.
I hereby certify, based upon information and
				  belief, that no more that five (5) actions or proceedings (including the
				  instant action or proceeding) pursuant to the commercial claims procedure have
				  been initiated in the courts of this State during the present calendar
				  month.
______________
Signature of Claimant
______________
Signature of Notary/Clerk/Judge
[FN1] NOTE: The commercial claims part will
				  dismiss any case where this certification is not made.
[FN1] NOTE: The commercial claims part will
				  not allow your action to proceed if this certification is not made and properly
				  completed.