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 A - Forms Authorized by Section 205.7 › Juvenile Delinquency Forms (Family Court Act Article 3) › Form 3-24 - Petition (modification of order of commitment)

Current through Register Vol. 46, No. 28, July
					 10, 2024
Sec. 322.1 F.C.A. Form 3-24
(Juvenile Delinquency)
7/83
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF ________
________
In the Matter of Docket No.
						________
________ PETITION
(Modification of Order of
A Person Alleged to be a
						Commitment)
Juvenile Delinquent,
________ Respondent.
________
TO THE FAMILY COURT:
The undersigned (appearing on behalf of
						the) Petitioner respectfully alleges that:
[FN1](1. Petitioner is the (Commissioner
						of Mental Health) (Commissioner of Mental Retardation and Developmental
						Disabilities) and pursuant to an order of this Court, dated ________, 19
						________, petitioning Respondent in the above-entitled proceeding has been
						committed to a residential facility within the appropriate office of the Mental
						Hygiene Department.)
[FN2](1. (S)he is the ________ of the
						petitioning respondent in the above-entitled proceeding and is appearing on
						behalf of said child for the purpose of filing this petition. Pursuant to an
						order of this Court dated ________, 19 ________, petitioning Respondent has
						been committed to a residential facility within the appropriate office of the
						Mental Health Department.)
2. Petitioner believes that the continued
						commitment of the above-named child in such residential facility is no longer
						appropriate in that ____________
WHEREFORE, Petitioner requests a hearing
						for a modification of the order of commitment dated ________, 19 ________, to
						authorize the transfer of Respondent to a non-residential facility.
Dated: ________, 19________.
(
______________
Commissioner
By
_____________
Name
______________
Title)
(By
_____________
On Behalf of the Petitioner (Child)
						)
VERIFICATION
(Agency)
STATE OF NEW YORK)
) ss.:
COUNTY OF ________)
________, being duly sworn, deposes and
						says:
That (s)he is the ________ of ________, an
						agency authorized to originate the above-entitled proceeding, and is acquainted
						with the facts and circumstances therein; that (s)he has read the foregoing and
						knows the contents thereof; that the same is true to (his) (her) own knowledge,
						except as to matters therein stated to be alleged on information and belief and
						as to those matters (s)he believes it to be true.
______________
Name
______________
Title
Sworn to before me this
________ day of ________,
						19________.
______________
(Notary Public)
VERIFICATION
(Individual)
STATE OF NEW YORK)
) ss.:
COUNTY OF ________)
________, being duly sworn, deposes and
						says:
That (s)he is the ________in the
						above-entitled proceeding and is acquainted with the facts and circumstances
						thereof; that (s)he has read the foregoing and knows the contents thereof; that
						the same is true to (his) (her) own knowledge, except as to matters therein
						stated to be alleged on information and belief and as to those matters (s)he
						believes it to be true.
____________
Sworn to before me this
________ day of ________,
						19________.
______________
(Deputy) (Clerk of the Court)
(Notary Public)
[FN1] Select applicable paragraph.
[FN2] Select applicable
						paragraph.