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 3-4 - Application-pre-petition detention

Current through Register Vol. 46, No. 28, July
					 10, 2024
F. C.A. §307.4 Form 3-4
(Juvenile Delinquency--
Pre-petition Detention Application)
2/2001
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of Docket No.
A Person Alleged to be a APPLICATION
						-
Juvenile Delinquent, PRE-PETITION
						DETENTION
Respondent.
________
TO THE FAMILY COURT:
The undersigned,, is the [state title]:
						of, the agency responsible for operating a detention facility at, New York, and
						respectfully alleges that:
1. (Upon information and belief,) on
						[specify date]:, a child named, who lives at [specify address]:, New York, and
						who was born on [specify date]: was taken into custody by [specify]: for having
						alledgedly committed the following delinquent act(s) [specify]:
2. (Upon information and belief,) the
						child was brought to this detention facility by [specify]: on [specify
						date]:
3. (Upon information and belief,) the
						child has not been released from this detention facility because
						[specify]:
4. (Upon information and belief,) this
						Court appears to have jurisdiction and the events occasioning the taking of the
						child into custody appear to involve acts constituting juvenile
						delinquency.
5. (Upon information and belief,) the
						child requires detention because [check applicable box(es) and state reasons]:
there is a substantial probability that
						the child will not appear in court on the return date, based upon the following
						facts and for the following reasons [specify]:
Form 3-4 Page 2
there is a serious risk that the child may
						before the return date commit an act which if committed by an adult would
						constitute a crime based upon the following facts and for the following reasons
						[specify]:
6.
a. Continued placement in the Respondent's
						home [check applicable box]: would would not be contrary to the Respondent's
						best interests, based upon the following facts and for the following specific
						reasons[specify]:
This assertion is based upon the following
						specific documents and evidence:
Probation Department report, dated
						[specify]:
Mental health evaluation, dated
						[specify]:
Other [specify]:
; AND
b. Reasonable efforts, where appropriate
						and consistent with the need for protection of the community, to prevent or
						eliminate the need for removal of the Respondent from the home or, if the
						Respondent was removed prior to the date of the hearing, to return the
						Respondent safely to his or her home:
were made as follows [specify reasonable
						efforts, including specific documents or evidence supporting findings]:
were not made but the lack of efforts was
						appropriate [check all applicable boxes]:
because of a prior judicial finding
						pursuant to Family Court Act §352.2(2)(c) that the authorized agency was
						not required to make reasonable efforts to reunify the Respondent with the
						parent(s) person(s) legally responsible [specify date of finding]:
because [specify other reasons]:
were not made.
This assertion is based upon the following
						specific documents and evidence:
Probation Department report, dated
						[specify]:
Mental health evaluation, dated
						[specify]:
Other [specify]:
7. No previous application has been made
						to any court or judge for the relief requested herein (except [specify]:).
Form 3-4 Page 3
WHEREFORE, the undersigned requests that
						an order be made directing that the child,, be detained at, a facility for the
						detention of juveniles at, New York, pending the further order of the Court,
						and directing such other and further relief as to the Court may seem just and
						proper.
Dated:
______________
(Agency)
By: ____________
______________
(Title)
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,.
______________
(Deputy) (Clerk of Court)
(Notary Public)